International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationMalignant Phyllodes Tumor of the Breast: Local Control Rates With Surgery Alone
Introduction
Cystosarcoma phyllodes or phyllodes tumors are rare tumors of the breast (1). Their clinical and pathologic characteristics may range from benign to highly malignant 1, 2. Complete surgical resection has high rates of local control and disease-free survival 3, 4, 5. However, a significant number of patients with malignant phyllodes tumors of the breast (MPTB) may develop local recurrence 4, 6, 7, 8. The potential value of adjuvant radiation therapy (RT) in reducing local recurrence rates is unclear and controversial because MPTB is rare and only a small fraction of patients received RT 3, 5, 6. As has been performed in dozens of studies of patients with breast carcinomas, determination of the potential value of RT for MPTB patients needs to be based on defining which patient subgroups are at risk of local recurrence after treatment with surgery alone. In this assessment, we take advantage of a national database to retrospectively review the recurrence risks of MPTB after local excision or mastectomy.
Section snippets
Methods and Materials
Records were available on 581 patients diagnosed with phyllodes tumors of the breast. These records were extracted from the National Oncology Database, a proprietary database of IMPAC Medical Systems (Sunnyvale, CA) consisting of merged tumor registries from more than 130 hospitals across the United States. Of these, 478 were coded as malignant. Only 12 of the 478 patients had adjuvant RT, and these were excluded from the analysis. This retrospective study was approved by the Institutional
Results
The median follow-up was 64 months (range, 0–410 months). Median patient age at diagnosis was 53 years (range, 14–100 years). There were 169 patients who were treated by lumpectomy alone and 207 who were treated by mastectomy alone. There were 327 patients for whom tumor size was recorded. There was no correlation between age and tumor size. The mean tumor size for African Americans was larger than for whites (8.2 cm vs. 6.2 cm, p < 0.05). The median age at diagnosis was 48.8 years for African
Discussion
Surgical resection alone yields long-term local control for the large majority of MPTB patients. For mastectomy patients in our review, the 5-year actuarial local control rate was 91.2%. This is in the range of 58–100% reported by others 4, 6, 7, 8. Mastectomy has been used in 52–87% of patients 3, 4, 5, 6, 7, 8, 9, 10. On the other hand, our study and others have shown that increasing numbers of patients are treated by breast-preserving lumpectomy procedures 3, 5. In our study, the 5-year
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2021, BreastCitation Excerpt :In this analysis, we reported an 88% and 69% LRFS rates at 5 years in patients with benign and borderline/malignant PT, respectively. These results fell in the 58–100% range that was previously published by several investigators.5,10-12 Factors found to affect local control of phyllodes tumors in literature included pathologic subtype, age, tumor size, type of surgery and surgical margin.12-15
Phyllodes tumor of the breast clinical experience and outcomes: A retrospective cohort tertiary hospital experience
2021, Annals of Diagnostic PathologyCitation Excerpt :The overall recurrence rate of our study was lower than the recurrence reported in other studies (14–40%) [8,11,12,14]. Pezner et al. reported a high recurrence rate of 36% [22]. Similar to our finding, Ogunbiyi et al. also recorded recurrence in 1 patient only (1.9%) who in contrast had a benign PT with positive surgical margin and followed the policy of wait and see [2].
The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08)
2019, Clinical Breast CancerCitation Excerpt :In this study we evaluated competing risk incidence rates of LR in patients initially treated with BCS alone to better define the potential need for adjuvant local therapy. Positive margin is a strong predictor of LR, for which the literature widely recommends re-excision or adjuvant whole-breast RT because of potential risk of metastatic spread and tumor-related mortality.22,23,33 Cosmetic morbidity is also another concern, because salvage therapy for LR demands repeat BCS or TM.
Multidisciplinary approach to a malignant phyllodes tumour of the breast in a 16-year-old woman
2020, Revista de Senologia y Patologia Mamaria
Presented at the 49th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), Los Angeles, CA, October 28–November 1, 2007.
Conflict of interest: none.