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Surgical restraint in Burkitt's lymphoma in children
J E Stein1, M R Schwenn, N N Jacir
1Division of Pediatric Surgery, Tufts University School of Medicine, Boston, MA.
Insights
Prompt chemotherapy is crucial for treating Burkitt's lymphoma. Surgery's role in Burkitt's lymphoma treatment is primarily for diagnosis, not resection, ensuring timely chemotherapy for better outcomes.
Area of Science:
- Oncology
- Pediatric Oncology
Background:
- Burkitt's lymphoma is characterized by rapid cell growth and bulky tumors.
- The role of surgery in managing Burkitt's lymphoma requires clarification.
Purpose of the Study:
- To review the role of surgery in the treatment of pediatric Burkitt's lymphoma.
- To evaluate the impact of surgical intervention on patient outcomes.
Main Methods:
- Retrospective review of nine pediatric patients (5-12 years) with Burkitt's lymphoma.
- Analysis of diagnostic procedures including oral/abdominal biopsies, paracentesis, gastroscopy, and exploratory laparotomy.
- Correlation of surgical role and timing of chemotherapy with patient survival.
Main Results:
- Eight of nine patients had abdominal involvement; two also had oral lesions.
- Four patients with confirmed diagnosis via biopsy or resection, followed by prompt chemotherapy, are alive without disease.
- Four patients died, two with delayed chemotherapy post-cytoreduction or gastroscopy.
Conclusions:
- Prompt chemotherapy is associated with the best outcomes in Burkitt's lymphoma.
- Surgery should be limited to obtaining diagnostic tumor samples for timely chemotherapy.
- Complete surgical resection is rarely feasible or indicated for Burkitt's lymphoma.
Abstract:
Burkitt's lymphoma is a disease of unique cytokinetics that account for the bulky tumors, variety of presenting symptoms, and sensitivity to chemotherapy. A need to ascertain the role of surgery in the treatment of this illness prompted this review. Of nine children 5 to 12 years of age with Burkitt's lymphoma, eight had abdominal involvement. Two of the eight patients also had oral lesions and staging was done by biopsy of the oral lesion and noninvasive imaging of the abdominal tumors. The other six patients presented with abdominal complaints. One of these had diagnostic paracentesis, another had only gastroscopy, and four underwent exploratory laparotomy. The four children in whom the diagnosis was established either by biopsy of an oral lesion, biopsy of an abdominal mass, or resection of an abdominal tumor are alive without evidence of disease 6 months to 6 years after treatment. Each of these children had rapid initiation of chemotherapy. Of the other four who died, two had delayed induction of drug therapy following cytoreduction or gastroscopic biopsy. The best outcomes were associated with prompt chemotherapy. We conclude that except in rare instances in which a solitary lesion lends itself to total or near-total resection, the proper role of surgery is a simple, safe procedure to obtain enough viable tumor for accurate diagnosis and prompt chemotherapy.