Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands.
Lancet Oncol. 2018 Aug;19(8):e407-e418. doi: 10.1016/S1470-2045(18)30356-5.
Incidence of primary CNS lymphoma (PCNSL) is increasing, while prognosis is improving as treatments advance. However, declined cognitive functioning remains a major challenge in the treatment of PCNSL. This cognitive decline, in conjunction with other symptoms caused by the disease or its treatment, or both, can compromise health-related quality of life (HRQOL). The aim of this Review was to give a comprehensive overview on cognitive functioning and HRQOL for patients with PCNSL, including an evaluation of patient-related and treatment-related factors that can influence cognitive functioning and HRQOL. We reviewed the literature for studies on cognitive functioning and HRQOL in newly diagnosed adult patients with PCNSL using MEDLINE/PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, CINAHL EBSCO, and Google Scholar, up to Jan 4, 2018. Articles were selected using predetermined inclusion and exclusion criteria; 42 articles were eligible for inclusion. Findings show that the tumour itself has a great effect on cognitive functioning and HRQOL. Initially, induction chemotherapy results in improvement of cognition and HRQOL in most patients. In the long-term, the addition of whole-brain radiotherapy has a negative effect on cognitive functioning, but the magnitude of this effect is not always clinically relevant. HRQOL scores were worse compared with controls, and worse after combined chemotherapy and radiotherapy when compared with chemotherapy only, particularly in the long term. Therefore, combined chemotherapy and radiotherapy seems to have a negative effect on HRQOL and cognition in patients with PCNSL. Although prolonged progression-free survival is achieved with combined treatment, information on its effect on cognition and HRQOL should be included in clinical decision-making.
原发性中枢神经系统淋巴瘤（PCNSL）的发病率正在增加，而随着治疗的进展，其预后也在改善。然而，认知功能的下降仍然是 PCNSL 治疗的一个主要挑战。这种认知能力下降，加上疾病或其治疗引起的其他症状，或者两者兼而有之，可能会影响健康相关生活质量（HRQOL）。本综述的目的是全面概述 PCNSL 患者的认知功能和 HRQOL，包括评估可能影响认知功能和 HRQOL 的患者相关和治疗相关因素。我们使用 MEDLINE/PubMed、Embase、Web of Science、Scopus、Cochrane、PsycINFO、CINAHL EBSCO 和 Google Scholar 检索了关于新诊断的成人 PCNSL 患者认知功能和 HRQOL 的研究文献，检索时间截至 2018 年 1 月 4 日。使用预定的纳入和排除标准筛选文章；有 42 篇文章符合纳入标准。研究结果表明，肿瘤本身对认知功能和 HRQOL 有很大影响。最初，诱导化疗使大多数患者的认知功能和 HRQOL 得到改善。从长期来看，全脑放疗的加入对认知功能有负面影响，但这种影响的程度并不总是具有临床意义。与对照组相比，HRQOL 评分较差，与单独化疗相比，联合化疗和放疗后更差，尤其是在长期。因此，联合化疗和放疗似乎对 PCNSL 患者的 HRQOL 和认知有负面影响。尽管联合治疗可实现无进展生存期的延长，但应将其对认知和 HRQOL 的影响纳入临床决策。
