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Imaging changes and cognitive outcome
in primary CNS lymphoma after enhanced chemotherapy delivery
Neuwelt EA, Guastadisegni PE, Varallyay P, Doolittle
ND
Department of Neurology, Oregon Health Sciences University, 3181 SW
Sam Jackson Park Road, Portland, OR 97239, USA. neuwelte@ohsu.edu
Background and Purpose. In children, MR imaging
abnormalities consistent with leukoencephalopathy after treatment for
hematologic malignancy do not correlate with neurologic dysfunction
and are often overinterpreted with regard to clinical
significance.
We hypothesized that this would also be true in primary CNS lymphoma
(PCNSL) patients who attained a complete response (CR) after treatment
with chemotherapy and osmotic blood-brain barrier disruption
(BBBD).
We hypothesized that cognitive function loss measured after tissue
diagnosis but before BBBD-enhanced chemotherapy could be correlated
with brain changes visualized by imaging, whereas a correlation would
not be present after therapy if the patient attained a complete tumor
response, analogous to the findings in children.
Methods. Sixteen primary
CNS lymphoma patients were followed after CR (no enhancing tumor) by
using a methotrexate-based regimen.
Neuropsychological (NP) cognitive testing and MR imaging or CT (when
MR imaging was not available) were performed before treatment and at
completion of the 12-month treatment for each patient.
Thereafter, the same studies were available for nine of these 16 CR
patients, who were followed for a median of 55 months.
Zone I was defined as enhancing tumor, and zone II as surrounding
abnormal MR T2 signal intensity or low-attenuation CT.
The cognitive scores were converted to Z scores and the MR T2 signal
intensity or CT low-attenuated changes were converted to a summary
zone II abnormality score.
Results. A significant
association between neurocognitive data and zone II abnormality was
found at baseline after tissue diagnosis but before chemotherapy (r =
-.55; P < .028), but no correlation existed at end of
treatment.
Imaging studies showed that seven patients developed a new T2 or
low-attenuation abnormality by the end of treatment, whereas 15
patients showed a decrease, stable appearance, or complete resolution
of their baseline zone II abnormality by end of treatment.
Although cognitive loss compared with age-matched control subjects was
common before starting therapy, by the end of treatment all patients'
cognitive function improved significantly (P < .005).
Conclusion. The current
data suggest that neither enhanced chemotherapy delivery nor changes
in MR imaging T2 signal intensity or CT low attenuation, in PCNSL
patients who attained a CR, were associated with a decrease in
cognitive function.
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