title: The evolving management of Burkitt's lymphoma at Red Cross Children's Hospital.
abstract: BACKGROUND
  Treatment for Burkitt's lymphoma at Red Cross Children's Hospital has evolved from the use of aggressive surgery and less intensive chemotherapy to a conservative surgical approach with more intensive chemotherapy.
  
  
  METHODS
  The study was a retrospective folder review of patients diagnosed with Burkitt's lymphoma at RCCH between 1984 and 2004.
  
  
  RESULTS
  Ninety-two children were treated for Burkitt's lymphoma at RCCH between 1984 and 2004. There were 10 patients with group A or fully resected disease, 52 with group B or extensive localised disease, and 30 with dissemination to the bone marrow and/or central nervous system or group C disease. Protocol 1 (less intensive chemotherapy based on the COMP regimen) was used from 1984, with protocol 2 (more intensive chemotherapy based on the LMB regimen) introduced in 1988 for group C disease, 1991 for group B disease and 1996 for group A disease. Overall 5-year survival increased from 20% with protocol 1 to 66% with protocol 2 for group C disease, and from 76.5% with protocol 1 to 88.2% with protocol 2 for group B disease. There were more admissions for neutropenic fever in patients on protocol 2 and more episodes of mucositis, and these patients required more red cell and platelet transfusions. With a more conservative surgical approach, biopsy largely replaced attempts to partially resect the tumour at primary surgery, and there was a consequent decline in surgical complications.
  
  
  CONCLUSIONS
  Intensive chemotherapy with protocol 2 has resulted in improved survival for group C and group B patients, but with more morbidity. Protocol 1, which is less intensive with less morbidity, remains a viable strategy for group A and group B disease in resource-poor settings.
authors.affiliation: Haematology Oncology Service, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital and University of Cape Town, South Africa. davidson@ich.uct.ac.za
authors.forename: Alan
authors.initials: A
authors.lastname: Davidson
authors.forename: Farieda
authors.initials: F
authors.lastname: Desai
authors.forename: Marc
authors.initials: M
authors.lastname: Hendricks
authors.forename: Patricia
authors.initials: P
authors.lastname: Hartley
authors.forename: Alastair
authors.initials: A
authors.lastname: Millar
authors.forename: Alp
authors.initials: A
authors.lastname: Numanoglu
authors.forename: Heinz
authors.initials: H
authors.lastname: Rode
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006766:Hospitals, County; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents