Pediatric Lymphoma

Incidence

SEER 1973-1987

Tumor % of pediatric cancers
Lymphoma 12.4%
HD 5.1%
NHL 3.8%
Burkitt's 1.5%
  • Almost all pediatric NHL is diffuse andhigh-grade

The three major histologic categories of NHL in children are

  • lymphoblastic
  • small noncleaved cell or Burkitt's
  • large-cell lymphoma

Clinical Presentation

  • 25% of pediatric NHL present with mediastinal disease (usually lymphoblastic with T-cell markers)
  • 30% have primary GI (usually undiffernetiated or small noncleaved)
  • 20-30% have H&N including Waldeyer's ring or cervical LN
  • 20-30% of patients with lymphoblastic or undifferentiated histology will have bone marrow metastatsis at presentation.

The role of RT

  • 2 prospective randomized trials for local RT in early-stage NHL found no benefit to the addition of local radiation therapy.
  • Limited to the following 4 situations

Emergency Radiation

Situation

  • mediastinal masses in children causing airway compromise or SVC compression
  • cord compression

Workup

  • Use least invasive procedure to establish diagnosis
    • attempt close examination of peripheral blood and bone marrow
    • attempt biopsy of lymph node outside of mediastinum
  • biopsy under general anesthesia should be avoided if possible if> 50% airway narrowing or symptoms of respiratory distress
  • prebiopsy use of RT or steroid for respiratory distress may jeopardize a tissue diagnosis.

Special Situation

  • if a tissue diagnosis cannot be established to allow administration of systemic therapy, appropriate definitive therapy will depend either on
    • biopsy of other disease or
    • on a presumed diagnosis.

Treatment

  • 1.5 to 2 Gy for a total of 6 to 7.5 Gy; or
  • hyperfractionated 1.2 to 1.5 Gy to 6 to 10 Gy.

Results

  • Symptoms relieved within 48 hours

Failure to obtain complete remission

Palliation

  • either prior to or following transplant.

Consolidation

* Consolidative RT is used for relapse or refractory disease either prior to or following transplant.

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