Initial Management of Advanced Burkitt Lymphoma in Children: Is There Still a Place for Surgery?

Abstract

This retrospective study compared the overall survival, the event-free survival, and the timing of chemotherapy in patients with advanced Burkitt lymphoma with and without laparotomy. Thirty-five patients with advanced abdominal Burkitt lymphoma treated at least partially at the Centre Léon Bérard between 1981 and 1992 were included in this study. The diagnosis was obtained by laparotomy (LAP group) in 21 patients (17 stage III, 4 stage IV) and by other methods (non-LAP group) in 14 patients (5 stage III, 9 stage IV). The overall survival (71 and 93%) and the event-free survival (66 and 79%) were similar in the LAP and non-LAP groups, and the relapse rate was five (three local) in the LAP group compared with three (none local) in the non-LAP group. The local complication rate (9 of 21 versus 2 of 14) and the toxic death rate (2 of 21 versus 1 of 14) were slightly higher in the LAP group. Laparotomy also caused delays in therapy and increased the overall hospital stay. The mean interval from diagnosis to the start of the fourth course of chemotherapy was 57 days compared with 48 days and the average hospital stay was 44.4 days compared with 39 days for the LAP and non-LAP groups, respectively. Because advanced Burkitt lymphoma can be diagnosed by fine-needle aspiration, and chemotherapy cures more than 80% of the patients, there is no need for initial surgery, apart from acute emergencies. Furthermore, laparotomy delay chemotherapy and might reduce the survival rate.

Primary gastric tumors of infancy and childhood: 54-year experience at a single institution

“…Although some authors advocate resection when possible [30,31], others advocate surgical intervention for acute complications only (eg, perforation, obstruction) [32,33]. Because no large trials are available comparing surgical treatment to chemotherapy, clinician judgment is necessary to decide whether surgical resection is indicated in each individual.…”

Improved outcome in children with advanced stage B-cell non-Hodgkin's lymphoma (B-NHL): results of the United Kingdom Children Cancer Study Group (UKCCSG) 9002 protocol

“…therapy and the reduction in early toxic death by avoiding unnecessary surgery coupled with aggressive treatment of biochemical and infectious complications soon after diagnosis or during induction (Lynch et al, 1977;Hann et al, 1990;Patte et al, 1991;Cairo et al, 1996;Miron et al, 1997). In the last decade the emphasis has been on trying to find prognostic factors that help to stratify patients and to deliver treatment according to risk group.…”

Burkitt’s and Burkitt-like Lymphoma

“…This is in part because of the typically rapid response of BL to systemic chemotherapeutic agents and radiation therapy. There is some controversy in the pediatric literature regarding varied therapeutic surgical interventions for patients with BL, but most physicians will avoid surgical debulking or other invasive surgical therapeutic options once BL has been diagnosed [59,60].…”