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White Matter Lesions and Encephalopathy in Patients Treated For Primary Central Nervous System Lymphoma

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Abstract

A retrospective analysis of the clinical presentations and neuroimaging characteristics of 33 patients with a primary central nervous system lymphoma (PCNL) who received cranial radiotherapy was performed to assess incidence of and risk factors for radiation-induced encephalopathy. CT and MRI scans were revised by a neurologist and a radiologist in conference. White matter abnormalities before and after radiotherapy on the last scan before recurrence were quantified according to a semi-quantitative scale. All available medical records were retrieved and reviewed with respect to demographic and tumor-related variables, treatment modalities, disease-free and overall survival and clinical symptoms and signs of encephalopathy. CT and MRI scans showed severe white matter lesions in 75% of 20 patients and in 86% of patients aged more than 60 years. Forty percent of patients presented with new clinical signs of cognitive impairment a median of 14.5 months after initial diagnosis (8.5 months after radiotherapy). The risk of white matter lesions appeared greater in patients aged > 60 (RR 1.2, 95% CI = 0.8–2.0), in patients with prior white matter lesions (RR 1.3, 95% CI = 0.8–2.1) and in patients with multifocal cerebral lymphoma (RR 1.5, 95% CI = 1.0–2.1). In conclusion, the risk of white matter lesions and clinical symptoms and signs of encephalopathy is high in patients treated by radiotherapy for PCNL. The risk appears to be greatest in older patients, patients with multifocal tumor and in those with prior white matter lesions on CT or MRI.

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References

  1. Eby NL, Grufferman S, Flannelly CM, Schol SC, Vogel FS, Burger PC: Increasing incidence of primary brain lymphoma in the US. Cancer 62: 2461–2465, 1988

    Google Scholar 

  2. Fine HA, Mayer RJ: Primary central nervous system lymphoma. Ann Intern Med 119: 1093–1104, 1993

    Google Scholar 

  3. Hochberg F, Miller D: Primary central nervous system lymphoma. J Neurosurg 68: 835–853, 1988

    Google Scholar 

  4. Murray K, Kun L, Cox J: Primary malignant lymphoma of the central nervous system: results of the treatment of 11 cases and review of the literature. J Neurosurg 65: 600–607, 1986

    Google Scholar 

  5. Rosenthal MA, Green MD: Cerebral lymphoma. In: Kaye AH, Laws Jr ER (eds) Brain Tumors. Churchill Livingstone, Edinburgh, 1995, pp 841–869

    Google Scholar 

  6. DeAngelis LM, Yaholom J, Thaler HT, Kher U: Combined modality therapy for primary CNS lymphoma. J Clin Oncol 10: 635–643, 1992

    Google Scholar 

  7. Ferreri AJM, Reni M, Bolognesi A, Verusio C, Villa E: Combined therapy for primary central nervous system lymphoma in immunocompetent patients. Eur J Cancer 31A: 2008–2012, 1995

    Google Scholar 

  8. Gabbai AA, Hochberg FH, Linggood R: High dose methotrexate therapy of primary brain lymphoma. J Neurosurg 70: 190–194, 1989

    Google Scholar 

  9. Glass J, Shustik C, Hochberg FH, Cher L, Gruber ML: Therapy of primary central nervous system lymphoma with pre-irradiation methotrexate, cyclophosphamide, doxorubicin, vincristine, and dexamethasone (MCHOD). J Neuro-Oncol 30: 257–265, 1996

    Google Scholar 

  10. Sarazin M, Ameri A, Monjour A, Nibio A, Poisson M, Delattre JY: Primary central nervous system lymphoma: treatment with chemotherapy and radiotherapy. Eur J Cancer 31A(12): 2003–2007, 1995

    Google Scholar 

  11. DeAngelis LM: Primary central nervous system lymphoma. J Neurol Neurosurg Psychiatry 66: 699–701, 1999

    Google Scholar 

  12. Jellinger K, Radaskiewicz TH, Slowik F: Primary malignant lymphomas of the central nervous system in man. Acta Neuropathol Suppl 6: 95–102, 1975

    Google Scholar 

  13. Henry JM, Heffner RR, Dillard SH, Earle KM, Davis RL: Primary malignant lymphomas of the central nervous system. Cancer 34: 1293–1302, 1974

    Google Scholar 

  14. Abrey LE, DeAngelis LM, Yahalom J: Long-term survival in primary CNS lymphoma. J Clin Oncol 16(3): 859–863, 1998

    Google Scholar 

  15. Blay J, Conroy T, Chevreau C, Thyss A, Quesnel N, Eghbali H, et al.: High-dose methotrexate for the treatment of primary cerebral lymphomas: analysis of survival and late neurologic toxicity in a retrospective series. J Clin Oncol 16(3): 864–871, 1998

    Google Scholar 

  16. Bleyer WA, Griffin TW: White matter necrosis, mineralizing microangiopathy, and intellectual abilities in survivors of childhood leukemia: associations with central nervous system irradiation and methotrexate therapy. In: Gilbert HA, Kagan AR (eds) Radiation Damage to the Nervous System. Raven Press, New York, 1980, pp 155–174

    Google Scholar 

  17. DeAngelis LM, Delattre JY, Posner JB: Radiation-induced dementia in patients cured of brain metastases. Neurology 39: 789–796, 1989

    Google Scholar 

  18. Mulhern RK, Ochs J, Kun LE: Changes in intellect associated with cranial radiation therapy. In: Gutin PH, Leibel SA, Sheline GE (eds) Radiation Injury to the Nervous System. Raven Press, New York, 1991, pp 325–340

    Google Scholar 

  19. Müller RP: Radiation-induced injury of the central nervous system. In: Dunst J, Sauer R (eds) Late Sequelae in Oncology. Springer-Verlag, New York, 1995, pp 23–27

    Google Scholar 

  20. Van Swieten JC, Hijdra A, Koudstaal PJ, Van Gijn J: Grading white matter lesions onCTand MRI: a simple scale. J Neurol Neurosurg Psychiatry 53: 1080–1083, 1990

    Google Scholar 

  21. Tsuruda JS, Kortman KE, Bradley WG, Wheeler DC, Van Dalsum W, Bradley TP: Radiation effects on cerebral white matter: MR evaluation. Am J Roentgenol 149: 165–171, 1987

    Google Scholar 

  22. Curran WJ, Hecht-Leavitt C, Schut L, Zimmerman RA, Nelson DF: Magnetic resonance imaging of cranial radiation lesions. Int J Radiat Oncol Biol Phys 13: 1093–1098, 1987

    Google Scholar 

  23. Constine LS, Konski MD, Ekholm S, McDonald S, Rubin P: Adverse effects of brain irradiation correlated with MR and_CT imaging. Int J Radiat Oncol Biol Phys 15: 319–330, 1988

    Google Scholar 

  24. Cher L, Glass J, Harsh GR, Hochberg FH: Therapy of primary CNS lymphoma with methotrexate-based chemotherapy and deferred radiotherapy: preliminary results. Neurology 46: 1757–1759, 1996

    Google Scholar 

  25. Freilich RJ, Delattre JY, Monjour A, DeAngelis LM: Chemotherapy without radiation therapy as initial treatment for primary CNS lymphoma in older patients. Neurology 46: 435–439, 1996

    Google Scholar 

  26. Sandor V, Stark-Vancs V, Pearson D, Nussenblat R, Whitcup SM, Brouwers P, et al.: Phase II trial of chemotherapy alone for primaryCNSand intraocular lymphoma. J Clin Oncol 16(9): 3000–3006, 1998

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University Medical Centre, Utrecht University, Utrecht, The Netherlands

    M.W.M. Wassenberg, J.E.C. Bromberg & M.J.B. Taphoorn

  2. Department of Radiology, University Medical Centre, Utrecht University, Utrecht, The Netherlands

    Th.D. Witkamp

  3. Department Of Radiotherapy, University Medical Centre, Utrecht University, Utrecht, The Netherlands

    C.H.J. Terhaard

Authors
  1. M.W.M. Wassenberg
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  2. J.E.C. Bromberg
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  3. Th.D. Witkamp
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  4. C.H.J. Terhaard
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  5. M.J.B. Taphoorn
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Wassenberg, M., Bromberg, J., Witkamp, T. et al. White Matter Lesions and Encephalopathy in Patients Treated For Primary Central Nervous System Lymphoma. J Neurooncol 52, 73–80 (2001). https://doi.org/10.1023/A:1010676807228

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