title: Hyperfractionated radiation therapy in Burkitt's lymphoma: a reconsideration aspect.
abstract: Burkitt's lymphoma (BL) is an aggressive non-Hodgkin's B-cell lymphoma with an extremely short doubling time that often presents in extra nodal sites or as an acute leukaemia. Nowadays, with the rapid response to chemotherapy and the diffuse nature of BL, there is no established role for radiation therapy (RT) even in localized disease. Regarding the relapsed/refractory BL, the treatment recommendations remain undefined. We present a 56-year-old woman, diagnosed with BL refractory to 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone), who had disease progression on R-DHAP (rituximab, dexamethasone, high dose cytarabine and cisplatin) with intrathecal methotrexate, then a partial response on RICE (rituximab, ifosfamide, carboplatin and etoposide). Patient received high dose chemotherapy and autologous haematopoietic stem cell transplantation. Then, she was treated with hyperfractionated involved-field RT regimen. Currently, the patient remains disease free for around 2 years after remission. We acknowledge that RT is not a standard treatment of BL, especially in patients who attain complete response (CR) after first-line multi-agent chemotherapy or even in those who have a CR after second-line chemotherapy pre-transplant. Yet, the use of a superfractionated regimen of consolidative radiation could be justified in the treatment of recurrent/refractory localized BL who do not achieve a CR even with second-line salvage chemotherapy. Radiation therapy in this context, given that it is a well-tolerated treatment, is a modality worthy of being re-considered in relapsed/refractory BL. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Khalil
authors.initials: K
authors.lastname: Charafeddine
authors.affiliation: Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Lara
authors.initials: L
authors.lastname: Hilal
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Bazarbachi
authors.affiliation: Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Nassima
authors.initials: N
authors.lastname: Salame
authors.affiliation: Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Bassem
authors.initials: B
authors.lastname: Youssef
mesh_terms: D002051:Burkitt Lymphoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015996:Survival Rate
keywords: Burkitt's lymphoma; radiation therapy; survival