Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy

Okita,Yoshiko; Narita,Yoshitaka; Miyakita,Yasuji; Miyahara,Ruriko; Ohno,Makoto; Takahashi,Masamichi; Nonaka,Masahiro; Kanemura,Yonehiro; Nakajima,Shin; Fujinaka,Toshiyuki

doi:10.3892/mco.2016.962

Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy

Authors:
- Yoshiko Okita
- Yoshitaka Narita
- Yasuji Miyakita
- Ruriko Miyahara
- Makoto Ohno
- Masamichi Takahashi
- Masahiro Nonaka
- Yonehiro Kanemura
- Shin Nakajima
- Toshiyuki Fujinaka
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Affiliations: Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan, Department of Neurosurgery and Neuro‑Oncology, National Cancer Center Hospital, Tokyo 104‑0045, Japan
Published online on: July 19, 2016 https://doi.org/10.3892/mco.2016.962
Pages: 179-185

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Abstract

Chemoradiotherapy for primary central nervous system lymphoma (PCNSL) is associated with a considerable risk of long-term neurotoxicity. The present study aimed to assess the health-related quality of life (HRQOL) of outpatients with PCNSL who have received radiotherapy and high-dose methotrexate (HDMTX) chemotherapy, and to determine the factors that cause a decline in HRQOL and interfere with home living. A total of 37 patients were surveyed 0.9‑14.2 years after their initial diagnosis and treatment. Each patient completed a multi‑part HRQOL questionnaire that was used to examine the associations of HRQOL scores with leukoencephalopathy, Karnofsky performance status (KPS) scores, age, history of recurrence and HDMTX-based chemoradiotherapy. The results demonstrated that the history of recurrence, number of cycles of MTX chemotherapy and age affected the development of leukoencephalopathy. Reductions in KPS score were associated with a history of recurrence (P=0.03), but not with leukoencephalopathy (P=0.8). KPS score, leukoencephalopathy and age were significantly associated with a decline in HRQOL score. A decline in the HRQOL associated with a reduction in KPS score was also observed by multivariate analyses. Deterioration of the HRQOL among outpatients with PCNSL post-chemoradiotherapy was significantly associated with older age (≥66 years) and decreased KPS score. Older patients with a history of recurrence had a higher risk for deteriorated QOL due to development of leukoencephalopathy. Therefore, it is recommended that clinicians monitor the KPS score among outpatients with PCNSL. QOL examination for older patients with a lower KPS score was found to be particularly important for identifying any obstacles for home living.

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