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Annals of Oncology Advance Access originally published online on February 6, 2007
Annals of Oncology 2007 18(7):1145-1151; doi:10.1093/annonc/mdl464
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© 2007 European Society for Medical Oncology

reviews

Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines

DD Correa1,*, L Maron2, H Harder3, M Klein4, CL Armstrong5, P Calabrese6, JEC Bromberg3, LE Abrey1, TT Batchelor7 and D Schiff8

1 Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY
2 Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
3 Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Rotterdam
4 Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
5 Division of Oncology, Children's Hospital of Philadelphia and University of Pennsylvania Medical School, Philadelphia, PA, USA
6 Department of Neurology, Ruhr-University, Bochum, Germany
7 Department of Neurology, Massachusetts General Hospital, Boston, MA
8 Division of Neuro-Oncology, University of Virginia Health Sciences Center, Charlottesville, VA, USA

* Correspondence to: Dr D. D. Correa, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA 10021. Tel: +1-212-639-2082; Fax: +1-646-422-2235; E-mail: corread{at}mskcc.org

Background: Treatment-related neurotoxicity has been recognized as a significant problem in patients with primary central nervous system lymphoma (PCNSL) as effective treatment has increased survival rates. There is, however, a paucity of research on cognitive functions in this population.

Design: In a review of the literature, a total of 17 articles that described cognitive outcome in adult PCNSL patients were identified.

Results: The studies that assessed cognitive functions after whole-brain radiotherapy combined with chemotherapy reported cognitive impairment in most patients. Patients treated with chemotherapy alone had either stable or improved cognitive performance in most studies. Methodological problems, however, limited the ability to ascertain the specific contribution of disease and various treatment interventions to cognitive outcome. On the basis of the literature review, a battery of cognitive and quality-of-life (QoL) measures to be used in prospective clinical trials was proposed. The battery is composed of five standardized neuropsychological tests, covering four domains sensitive to disease and treatment effects (attention, executive functions, memory, psychomotor speed), and QoL questionnaires, and meets criteria for use in collaborative trials.

Conclusion: The incorporation of formal and systematic cognitive evaluations in PCNSL studies will improve our understanding of treatment-related neurotoxicity in this population.

Key words: chemotherapy, cognitive, neurotoxicity, primary CNS lymphoma, radiotherapy

Received for publication August 30, 2006. Revision received November 9, 2006. Accepted for publication November 10, 2006.


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