Effect of adjuvant radiotherapy on overall survival and breast cancer-specific survival of patients with malignant phyllodes tumor of the breast in different age groups: a retrospective observational study based on SEER.

PURPOSE: Malignant phyllodes tumor of the breast (MPTB) is a rare type of breast cancer, with an incidence of less than 1%. The value of adjuvant radiotherapy (RT) for MPTB has been controversial. The aim of the study was to explore the effect of radiotherapy on the long-term survival of female patients with MPTB at different ages. METHODS: Female MPTB patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2020. A Kaplan-Meier survival analysis was conducted to investigate the value of RT for the long-term survival of MPTB patients in different age groups. Additionally, univariate and multivariate Cox regression analyses were performed for overall survival (OS) and breast cancer-specific survival (BCSS) of MPTB patients. Furthermore, propensity score matching (PSM) was also performed to balance the differences in baseline characteristics. RESULTS: 2261 MPTB patients were included in this study, including 455 patients (20.12%) with RT and 1806 patients (79.88%) without RT. These patients were divided into four cohorts based on their ages: 18-45, 46-55, 56-65, and 65-80. Before adjustment, there was a statistically significant difference in long-term survival between RT-treated and non-RT-treated patients in the younger age groups (age group of 18-45 years: OS P = 0.019, BCSS P = 0.016; age group of 46-55 years: OS P < 0.001, BCSS P < 0.001). After PSM, no difference was found in long-term survival of patients in both younger and older groups regardless of whether they received RT (age group of 18-45 years: OS P = 0.473, BCSS P = 0.750; age group of 46-55 years: OS P = 0.380, BCSS P = 0.816, age group of 56-65 years: OS P = 0.484, BCSS P = 0.290; age group of 66-80 years: OS P = 0.997, BCSS P = 0.763). In multivariate COX regression analysis, RT did not affect long-term survival in patients with MPTB. CONCLUSION: There is no evidence that long-term survival of MPTB patients in specific age groups can benefit from RT.

Effect of radiation therapy on patients with stage T3 or T4 malignant phyllodes tumors: a retrospective observational study based on SEER.

PURPOSE: Among all primary breast tumors, malignant phyllodes tumor of the breast (MPTB) make up less than 1%. In the treatment of phyllode tumors, surgical procedures such as mastectomy and breast-conserving surgery are the mainstay. MPTB has, however, been controversial when it comes to treating it with RT. We aimed to explore the prognostic impact of RT and other clinicopathologic factors on long-term survival for patients with stage T3 or T4 malignant phyllodes tumors. METHODS: We select patients with stage T3 or T4 MPTB who qualified for the criteria between 2000 and 2018 via the Surveillance, Epidemiology, and End Results (SEER) database. We performed 1:1 propensity score matching (PSM) and Kaplan-Meier analysis to explore the role of RT in long-term survival of patients with stage T3 or T4 MPTB. A univariate and multivariate analysis of breast cancer-specific survival (BCSS) and overall survival (OS) risk factors was carried out using a Cox proportional hazards model. In addition, the nomogram graph of OS and BCSS was constructed. RESULTS: A total of 583 patients with stage T3 or T4 malignant phyllodes tumors were included in this study, of whom 154 (26.4%) received RT, and 429 (73.6%) were treated without RT. Before adjustment, between groups with and without RT, BCSS (p = 0.1) and OS (p = 0.212) indicated no significant difference respectively. Using of PSM, the two groups still did not differ significantly in BCSS (p = 0.552) and OS (p = 0.172). In multivariate analysis, age (p < 0.001), surgery of primary site (p < 0.001) and distant metastatic status (p < 0.001) were related to prognosis, while RT still did not affect BCSS (p = 0.877) and OS (p = 0.554). CONCLUSION: Based on the SEER database analysis, the study suggests that the patients with stage T3 or T4 MPTB treated with RT after surgery didn't have significant differences in BCSS or OS compared to those not treated with RT.

Successful Treatment of a Locally Recurrent and Metastatic Malignant Phyllodes Tumor with Accelerated Radiotherapy and Nab-Paclitaxel, Cisplatin, and Liposomal Doxorubicin Chemotherapy.

Phyllodes tumors are rare breast lesions of fibroepithelial origin. Malignant transformation with metastases is linked with poor prognosis. We present a case of a 62-year-old woman with a recurrent malignant phyllodes tumor of the breast and lung metastases. The patient was originally presented with a borderline phyllodes tumor (7.4 cm) of the left breast, treated with wide local excision. A year later, the patient returned with palpable left breast masses. On PET-CT, increased uptake of 18F-FDG by large breast tumors was evident. A right lung lesion of metastatic origin was also present. A simple left breast mastectomy was performed. Histopathological report described 2 malignant phyllodes tumors (7 cm and 6.5 cm). One month later, during the CT simulation for radiotherapy planning, encysted fluid in the chest wall and 2 additional pulmonary lesions of the right lung were identified, confirming progressive lung metastatic disease. Both the chest wall and the regional lymph node area were irradiated with hypofractionated and accelerated radiotherapy. Biweekly chemotherapy with albumin-bound paclitaxel, cisplatin, and liposomal doxorubicin was also prescribed at the start of radiotherapy for 12 cycles. At the end of chemotherapy, complete regression of lung metastases was achieved, and there was no evidence of local recurrence. Within 2 years of follow-up, the patient is free of disease and treatment-related toxicities. Accelerated hypofractionated radiotherapy is effective in the locoregional control of malignant phyllodes tumors. The combination of cisplatin with nab-paclitaxel and liposomal doxorubicin chemotherapy has acceptable toxicity and is highly effective in eradicating metastatic lesions.

Phyllodes tumors of the breast: Adjuvant radiation therapy revisited.

BACKGROUND: Phyllodes tumors (PT) are rare entity and surgical resection is the cornerstone of treatment. No standard of care exists regarding adjuvant treatment especially radiation therapy (RT). PATIENTS AND METHODS: We analyzed all patients with non-metastatic, resected phyllodes tumors who presented to our institution from January 2005 through December 2019. Primary study endpoints included local recurrence free survival (LRFS) and overall survival (OS). RESULTS: One hundred and eight patients were analyzed (patients with incomplete treatment and follow up data were excluded). Fifty patients had benign phyllodes, 26 patients had borderline and 32 patients had malignant phyllodes. In the benign group, no significant difference in LRFS was observed between patients who received adjuvant RT (n = 3) and those who did not (5-year LRFS 100% vs. 85% respectively, p = 0.49). The 5 year OS for patients who received RT was 60% vs. 89% for those who did not (p 0.40). In the borderline/malignant group, adjuvant RT significantly improved five year LRFS (90% in the RT group vs. 42% in the no RT group, p = 0.005). The 5 year LRFS in patients treated with margin negative breast conserving surgery and RT was 100% vs. 34.3% in patients who did not receive RT (p 0.022). Patients treated with mastectomy and RT had a 5 year LRFS of 100% vs. 83% for patients who did not receive RT (p 0.24). On multivariate analysis, radiation therapy was independently associated with decreased hazard of local failure (HR 0.21, CI 0.05-0.89, p = 0.03). No difference in OS was found between the RT and no RT groups (5-year OS was 52% vs. 45% respectively, p 0.54). CONCLUSION: The results of the current study confirm the excellent prognosis of benign phyllodes tumors; warranting no further adjuvant treatment after margin-negative surgical resection. For patients with borderline/malignant phyllodes tumors, adjuvant radiation therapy significantly improved LRFS after margin negative wide local excision; however, patients treated with mastectomy did not attain the same benefit from adjuvant irradiation.

Patterns of care and predictors of adjuvant radiation therapy in phyllodes tumor of the breast.

Patterns of care, utilization, and predictors of adjuvant radiation therapy (RT) for phyllodes tumors of the breast were retrospectively analyzed using the National Cancer Database. We identified 3080 patients; 53.4% received lumpectomy and 35.9% mastectomy. 25.9% of patients had lymph node sampling or dissection. 23.2% received adjuvant RT, which doubled in utilization over a decade. Predictors of RT were younger age, fewer comorbidities, less favorable pathologic features, and treatment at academic centers. There was no association between RT and overall survival (AHR 1.21, 95% CI 0.97-1.53, P = .097). Despite national guidelines recommending against nodal sampling or RT, it remains prevalent. Further research on indications for adjuvant radiation for phyllodes is needed.

Risk Factors for Recurrence of Malignant Phyllodes Tumors of the Breast.

BACKGROUND/AIM: In this study, the treatment outcome and risk factors for recurrence in patients undergoing surgery with or without adjuvant radiotherapy (RT) for malignant phyllodes tumors of the breast (MPTB) were analyzed. PATIENTS AND METHODS: Forty-three patients (61.4%) underwent breast-conserving surgery (BCS) and 27 (38.6%) underwent mastectomy. Fifteen patients (21.4%) received adjuvant RT. RESULTS: With a median follow-up of 76 months, the 7-year local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and cause-specific survival (CSS) rates were 90.7%, 85.2%, 80.3%, and 87.1%, respectively. Either the extent of surgery or treatment with adjuvant RT did not affect the outcomes. On multivariate analysis, the presence of tumor necrosis was associated with inferior DFS (p=0.017), while infiltrative tumor border showed a marginal significance (p=0.078). When stratified using these two adverse pathological features, the 7-year DFS rates were 100%, 54.9%, and 55.6% in patients with 0, 1, and 2 risk factors, respectively (p=0.002). CONCLUSION: MPTB patients undergoing surgery with or without adjuvant RT had a favorable outcome. Although there was no local recurrence in patients treated with adjuvant RT, the effect of adjuvant RT failed to reach a statistical significance. Risk-grouping based on pathological features might help design a clinical trial for MPTB.

Effect of postoperative time for adjuvant radiotherapy in malignant phyllodes tumor: An institutional experience.

INTRODUCTION: Cystosarcoma phyllodes of the breast, an uncommon sarcoma found primarily in women of the age group of 35-55 years, constitutes <1% of all breast neoplasms. These tumors are resistant to chemotherapy and hormonal therapies and often recur aggressively after initial surgery. Limited research is available about the role and effectiveness of adjuvant radiotherapy in reducing recurrences. OBJECTIVES: Surgery has been the primary treatment modality to date but with high recurrence rates. The purpose of this retrospective study is to highlight the role of postoperative time for adjuvant radiotherapy in aggressive borderline and malignant phyllodes tumor (PT). MATERIALS AND METHODS: This retrospective study reviewed 13 histopathologically proven borderline and malignant PT, treated with radiation therapy to the dose of 50 Gray by external beam radiotherapy (EBRT) after primary surgical management. RESULTS: The mean age at presentation was 33 years. Right laterality was more common (60% cases). Although all patients presented with lump, those who had pain as an added symptom turned out to be histopathologically malignant later on. Histopathologically, 66.6% patients were malignant, 20% borderline, and 13.3% benign. High mitotic index and stromal activity were observed in younger patients. Patients who received EBRT within a month of surgery had no local recurrence, whereas those who received EBRT after a month developed local recurrence (P = 0.012). CONCLUSION: Adjuvant radiotherapy is appropriate treatment for aggressive borderline and malignant PT. This study revealed that time interval between surgery to initiation of EBRT plays a significant role in the prevention of recurrence.

[Breast osteosarcoma originating in a phyllodes tumor. Report of one case]. / Tumor Phyllodes con transformación a osteosarcoma.

Phyllodes tumors account for less than 1% of tumors of the mammary gland, have both epithelial and stromal components and are classified as benign, borderline and malignant. The malignant tumors are highly heterogeneous: they can differentiate to liposarcomas, fibrosarcomas, rhabdomyosarcomas, chondrosarcomas or osteosarcomas. The differentiation to osteosarcoma is extremely rare, constitutes 1.3% of cases and is very aggressive. The standard treatment of these tumors is surgical. The role of radiotherapy and chemotherapy is not clear. However, in patients in whom wide surgical margins are not achieved, adjuvant radiotherapy can be of help. We report a 63 years old female with a right breast osteosarcoma with an osteoclastic component, originating in a phyllodes tumor. The tumor was excised surgically and afterwards she was treated with 10 sessions of 50 Gy of radiotherapy in 25 fractions. She has remained free of disease for the last 10 months.

Tumor Phyllodes con transformación a osteosarcoma / Breast osteosarcoma originating in a phyllodes tumor: report of one case

Phyllodes tumors account for less than 1% of tumors of the mammary gland, have both epithelial and stromal components and are classified as benign, borderline and malignant. The malignant tumors are highly heterogeneous: they can differentiate to liposarcomas, fibrosarcomas, rhabdomyosarcomas, chondrosarcomas or osteosarcomas. The differentiation to osteosarcoma is extremely rare, constitutes 1.3% of cases and is very aggressive. The standard treatment of these tumors is surgical. The role of radiotherapy and chemotherapy is not clear. However, in patients in whom wide surgical margins are not achieved, adjuvant radiotherapy can be of help. We report a 63 years old female with a right breast osteosarcoma with an osteoclastic component, originating in a phyllodes tumor. The tumor was excised surgically and afterwards she was treated with 10 sessions of 50 Gy of radiotherapy in 25 fractions. She has remained free of disease for the last 10 months.

Tumor phyllodes maligno gigante de mama; neoplasia infrecuente de mal pronóstico: a propósito de un caso clínico / Giant phyllodes tumor of the breast; uncommon neoplasm of poor prognosis: clinical case

Los tumores Phyllodes agrupan un conjunto de patologías caracterizadas por presentar una arquitectura histológica estromal y epitelial; dividiéndose en benignos, borderline o malignos, en función de múltiples características. Se desarrollan más frecuentemente en pacientes entre los 35-55 años de edad, representando el 0.3%-1% de los tumores primarios de la mama. Clínicamente se caracterizan por la aparición de una masa indolora, firme, dura, multilobulada y de crecimiento rápido que puede llegar a alcanzar un gran tamaño, denominándose gigantes cuando superan los 10 cm de longitud. El diagnóstico de los tumores Phyllodes, se basa en el estudio anatomopatológico mediante biopsia radioguiada y las pruebas de imagen mamarias. La cirugía conservadora o radical, con márgenes de resección quirúrgica libres de enfermedad mayores de 1 cm, y la radioterapia adyuvante sobre el lecho tumoral, son el tratamiento de elección de este tipo de tumores. El tamaño de la masa, el tipo histológico y la afectación tumoral de los bordes quirúrgicos son los principales factores de riesgo de recurrencia, que puede alcanzar un 40%, siendo casi siempre a nivel local. Por otro lado, la probabilidad de desarrollar metástasis a distancia presenta una mayor variabilidad, siendo más frecuente a nivel pulmonar y óseo. A continuación, presentamos el caso de una paciente diagnósticada de un tumor Phyllodes maligno gigante de mama derecha (mayor de 20 cm) que, tras tratamiento mediante cirugía radical y radioterapia adyuvante, desarrolló múltiples metástasis a distancia, recibiendo actualmente cuidados paliativos, a pesar de los esfuerzos terapéuticos multidisciplinares realizados.

Those Phyllodes tumors grouped a set of pathologies characterized by presenting an architecture histological stromal and epithelial; divided into benign, borderline or malignant, based on multiple characteristics. Occur most frequently in patients between 35-55 years of age, representing 0.3% - 1% of primary tumors of the breast. Clinically is characterized by the appearance of a mass painless, firm, hard, multilobulated and of growth fast that can get to reach a great size, calling is giant when exceed the 10 cm of length. Phyllodes tumors diagnosis, based on the study pathological radioguided biopsy and breast imaging tests. It surgery conservative or radical, with margins of resection surgical free of disease greater of 1 cm, and the radiation therapy adjuvant on the bedding tumor, are the treatment of choice of this type of tumors. He size of the mass, the type histologically and it involvement tumor of them edges surgical are the main factors of risk of recurrence, that can reach a 40%, being almost always to level local. On the other hand, the probability of developing metastasis to distance presents a greater variability, being more frequent to level lung and bone. Then, present the case of a patient diagnosed of a tumor Phyllodes malignant giant of mama right (greater of 20 cm) that, after treatment by surgery radical and radiotherapy adjuvant, developed multiple metastasis to distance, receiving currently care palliative, despite those efforts therapeutic multidisciplinary made.

Outcomes of Prosthetic Reconstruction of Irradiated and Nonirradiated Breasts with Fat Grafting.

BACKGROUND: Fat grafting may be beneficial in prosthetic reconstruction of irradiated tissues, but there is a paucity of data on the complication rates associated with this clinical scenario. METHODS: All consecutive patients who had undergone fat grafting and prosthetic reconstruction from 2010 to 2013 were enrolled. Variables obtained related to fat grafting and history of irradiation. Implant-related complications in relation to irradiation status were also noted. RESULTS: Eighty-five patients (age 49 ± 10 years) underwent 117 fat grafting procedures. The mean follow-up was 2.6 ± 0.7 years. Fat grafting was predominantly performed to correct soft-tissue deficiency [112 of 117 (95.7 percent)] or to alter skin after irradiation [five of 117 (4.3 percent)]. Thirty-two procedures (27.4 percent) were associated with a complication, with the most common being palpable fat necrosis (23.1 percent). Volume of transferred fat averaged 151.2 ± 76.6 ml per breast. Fat grafting complications did not depend on donor site, technique of fat processing, volume of transferred fat, number of procedures, or irradiation. Implant-related complications were observed after 26 of 117 overall procedures (22.2 percent). No association between implant-related complications and irradiation was observed (OR, 1.3; 95 percent CI, 0.4 to 4.1; p = 0.63). Overall complications following fat grafting in nonirradiated [37 of 82 (45.1 percent)] and irradiated [16 of 35 (45.7 percent)] breasts were not statistically different (OR, 1.02; 95 percent CI, 0.41 to 2.57; p = 0.96). CONCLUSION: Similar outcomes of irradiated and nonirradiated prosthetic breast reconstruction can be achieved with additional fat grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Radiation therapy for malignant phyllodes tumor of the breast: An analysis of SEER data.

PURPOSE: Malignant phyllodes tumor of the breast (MPTB) accounts for less than 1% of whole breast neoplasm. Surgery is regarded as the primary treatment of choice in patients with MPTB, but the necessity of postoperative radiation therapy (RT) has been a subject of debate. Our aim was to evaluate effects of postoperative RT for MPTB using a large population database. METHODS: Using the Surveillance, Epidemiology, and End Results Program (SEER) database (1983-2013), clinico-pathologic prognostic factors were evaluated. Postoperative RT, tumor extent, grade, and lymph node (LN) metastasis were included in the analysis. Univariate and multivariate Cox proportional hazards regressions were performed to evaluate prognostic power of variables on cancer specific survival (CSS). RESULTS: A total of 1974 patients with MPTB were reviewed. Of these, 825 (42%) and 1149 (58%) patients underwent mastectomy and breast conserving surgery (BCS), respectively. In each group, 130 (16%) and 122 (11%) patients received postoperative RT. For patients with adverse risk factors including high grade and large tumor size, postoperative RT was more likely to be performed. In multivariate analysis, age, ethnicity, tumor size, tumor extension and LN status were correlated with prognosis in mastectomy group, while postoperative RT did not affect CSS. In BCS group, age and grade were significant prognostic factors on CSS, meanwhile postoperative RT did not impact CSS in multivariate analysis. CONCLUSION: Although patients with more adverse prognostic factors underwent postoperative RT, RT groups were not inferior to non-RT group on CSS regardless of surgery (mastectomy or BCS).

Phyllodes tumors of the breast: Analysis of 35 cases from a single institution.

BACKGROUND: Phyllodes tumors are rare fibroepithelial breast tumors with diverse biological behavior. Our study aim is to review the clinico-pathological features, prognostic factors and treatment outcome for patients presenting with phyllodes tumors of the breast to the Kuwait Cancer Control Center (KCCC). PATIENTS AND METHODS: We retrospectively reviewed the clinical and pathological data of 35 women of histologically proved phyllodes tumors of the breast retrieved between January 1994 and December 2012. RESULTS: The median age was 40years (21-63years). The median pathological tumor size was 6.8cm (3-25cm). Histologically, one patient (3%) presented with benign, 13 (37%) with borderline and 21 (60%) with malignant phyllodes. Twenty-eight patients (80%) were premenopausal. Twenty (57%) were ultimately treated with mastectomy (3 borderline, and 17 malignant) and 15 (43%) with conservative surgery (1 benign, 10 borderline and 4 malignant). Axillary staging was carried out in 9 patients (1 borderline and 8 malignant), none of them had nodal metastasis. Four patients with malignant phyllodes received postoperative radiotherapy. After a median follow-up period of 52months (range 5-211months), 5 developed local recurrence (1 benign, 2 borderline and 2 malignant). One patient with malignant phyllodes developed distant lung metastasis. The overall 5-year relapse free survival (RFS) was 74% (68% for borderline and 84% for malignant phyllodes). According to the treatment modality, the 5-year RFS was 69% for conservative surgery compared to 87% for mastectomy. It was 100% for irradiated patients versus 71% for non irradiated patients. CONCLUSION: Phyllodes tumors are rare tumors that occur in relatively young women, when compared with the classical adenocarcinoma of the breast. They have a tendency to reach large sizes with absence of nodal metastasis. Although surgery is the mainstay of management, postoperative radiotherapy also appears to decrease the local recurrence rates in certain presentations.

Phyllodes tumours of the breast: retrospective analysis of a University Hospital's experience.

Taking cognizance of the purported variation of phyllodes tumours in Asians compared with Western populations, this study looked at phyllodes tumours of the breast diagnosed at the Department of Pathology, University of Malaya Medical Centre over an 8-year period with regards to patient profiles, tumour parameters, treatment offered and outcome. Sixty-four new cases of phyllodes tumour were diagnosed during the period, however only 30 (21 benign, 4 borderline and 5 malignant) finally qualified for entry into the study. These were followed-up for 4-102 months (average = 41.7 months). Thirteen cases (8 benign, 3 borderline, 2 malignant) were Chinese, 9 (all benign) Malay, 7 (4 benign, 1 borderline, 2 malignant) Indian and 1 (malignant) Indonesian. Prevalence of benign versus combined borderline and malignant phyllodes showed a marginally significant difference (p=0.049) between the Malays and Chinese. Patients' ages ranged from 21-70 years with a mean of 44.9 years with no significant difference in age between benign, borderline or malignant phyllodes tumours. Except for benign phyllodes tumours (mean size = 5.8 cm) being significantly smaller at presentation compared with borderline (mean size = 12.5 cm) and malignant (mean size = 15.8 cm) (p<0.05) tumours, history of previous pregnancy, breast feeding, hormonal contraception and tumour laterality did not differ between the three categories. Family history of breast cancer was noted in 2 cases of benign phyllodes. Local excision was performed in 17 benign, 2 borderline and 3 malignant tumours and mastectomy in 4 benign, 2 borderline and 2 malignant tumours. Surgical clearance was not properly recorded in 10 benign phyllodes tumours. Six benign and all 4 borderline and 5 malignant tumours had clearances of <10 mm. Two benign tumours recurred locally at 15 and 49 months after local excision, however information regarding surgical clearance was not available in both cases. One patient with a malignant tumour developed a radiologically-diagnosed lung nodule 26 months after mastectomy, was given a course of radiotherapy and remained well 8-months following identification of the lung nodule.

[A Case of Malignant Phyllodes Tumor Effectively Treated by Radiation Therapy as a Palliative Medicine].

The current report presents the case of a 46-year-old woman with phyllodes tumor metastasis to the anterior chest wall treated by radiation therapy. Although the lesion was not controlled with surgery and chemotherapy, the tumor size markedly reduced after radiation therapy, and bleeding and foul odor from the tumor stopped. Radiation therapy for phyllodes tumor appears to be an effective treatment and should be recognized as one choice of palliative medicine.

Malignant phyllodes tumor of the breast with liposarcomatous differentiation and intraductal hyperplasia.

Phyllodes tumor of the breast is a biphasic fibroepithelial neoplasm. 10 to 20% of phyllodes tumor show malignant transformation, often in the form of stroma, which usually shows fibrosarcomatous differentiation and rarely heterologous sarcomatous elements. Liposarcomatous differentiation is not common among phyllodes tumors. The correct diagnosis of heterologous liposarcomatous differentiation in a malignant PT requires identification of the biphasic component of the tumor. We reported a case of malignant phyllodes tumor which initially transformed into liposarcoma, in addition to a very rare intraductal hyperplasia and flat epithelial atypia. The patient was a 75-year-old woman, with a lump in the left breast without axillary lymphadenopathy. She also have a positive family history of breast carcinoma. She underwent surgery and still alive and disease free after one year.

Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998-2009.

BACKGROUND: Malignant phyllodes tumors of the breast have traditionally been treated with surgical excision. Recently, the use of adjuvant radiotherapy has been advocated to reduce the risk of local recurrence; however, this recommendation is controversial in the absence of consistent outcome data. We hypothesize that there has been a trend toward increased utilization of adjuvant radiotherapy for malignant phyllodes tumors despite its uncertain effect on outcomes. METHODS: Using the National Cancer Data Base, predictors of radiotherapy utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan-Meier and Cox regression models were generated to determine the effect of radiotherapy on local recurrence (LR), disease-free survival (DFS), and overall survival (OS). RESULTS: Of the 3,120 patients with malignant phyllodes, 57 % underwent breast conservation surgery and 42 % underwent mastectomy. Overall, 14.3 % of women received adjuvant radiotherapy. Utilization of radiotherapy doubled over the study period (9.5 % in 1998-1999 vs. 19.5 % in 2008-2009, p < 0.001). Women were significantly more likely to receive radiotherapy if they were diagnosed later in the study, were age 50-59 years old, had tumors >10 cm, or had lymph nodes removed. For the 1,774 patients with available recurrence data, overall recurrence was 14.1 %, and LR was 5.9 %. In adjusted models, adjuvant radiotherapy reduced LR (aHR 0.43, 95 % CI 0.19-0.95) but did not impact DFS or OS after 53 months' median follow-up. CONCLUSIONS: Utilization of adjuvant radiotherapy for malignant phyllodes doubled from 1998 to 2009. Radiotherapy significantly reduced LR but had no effect on DFS or OS.

Challenges in management of phyllodes tumors of the breast: a retrospective analysis of 150 patients.

INTRODUCTION: Phyllodes tumors (PT) of the breast seem to get pre-operatively misdiagnosed as fibroadenomas resulting in inadequate resections and high local recurrence rates. MATERIALS AND METHODS: Data of 150 patients with PT of the breast managed from January, 2003 to February, 2013 were retrospectively analyzed. Statistical analysis performed using SPSS version 17 (Pearson Chi-square test and analysis of variance test for analysis). AIM: The aim of this study is to compare clinico-pathological profile and recurrence rates in patients with benign (B), borderline malignant (BL) and malignant (M) PT. RESULTS: In a total of 150 patients with PT (n = 77 B, n = 24 BL, n = 49 M), mean age was 36.92, 44.04 and 40.46 years respectively (P 0.015) and mean tumor size being 8.15 cm, 14.7 cm and 12.9 cm respectively (P 0.000). Pre-operatively cytology suggestive of PT in 24% patients with B PT and 63% in M PT; core tissue biopsy suggestive of PT in 85.4% patients with B PT and 100% in M PT. Recurrence seen in 34.7% out of which 32.7% were post-lumpectomy performed elsewhere. Majority of B PT had lumpectomy (49.3%)/wide local excision (WLE, 31.2%) compared with M PT where 55.1% had simple mastectomy (SM) due to large tumor size. Local recurrence was more in M PT (53%) compared with B PT (20%). We found recurrence rates in L (39.3%) compared with WLE (27.3%) and SM (33.9%) (P 0.049). CONCLUSIONS: Larger tumor size, incomplete resection and M/BL histology predicted higher recurrence in PT. Core biopsy is much more accurate than fine needle cytology in the diagnosis.

Manejo clínico, tratamiento y control local del tumor phyllodes mamario / Clinical management, treatment and local control of phyllodes tumors

Objetivo. Describir nuestra casuística de los últimos 13 años de acuerdo con un manejo clínico-quirúrgico y control local del tumor phyllodes según el grado tumoral. Material y método. Estudio descriptivo retrospectivo de todos los casos diagnosticados de tumor phyllodes mamario (N = 34) procedentes del Servicio de Anatomía Patológica del Hospital Clínico San Carlos de Madrid entre 1997-2010. Se realizó un análisis de los factores clínico-patológicos que pueden influir en la recidiva y en el intervalo libre de enfermedad. Resultados. La media de edad de las pacientes al diagnóstico fue de 41 años (± 13,3). Se realizó una primera cirugía conservadora en todas las pacientes (N = 34), y en 17 casos, segundas cirugías (50,0%). En 7 casos fueron mastectomías: 5 mastectomías simples y 2 mastectomías con linfadenectomía axilar. Tres casos de mastectomía se realizaron en tumor phyllodes benigno y tamaño tumoral voluminoso (12%) para lograr un buen resultado estético y en 2 pacientes con tumores phyllodes maligno (33,3%). En los otros 2 casos, además de la mastectomía se realizó una linfadenectomía axilar, en un caso por tumor phyllodes maligno con histología agresiva y en otro por recidiva voluminosa de tumor phyllodes benigno, sin evidencia de enfermedad en ambos vaciamientos axilares. En el análisis univariante hubo diferencias significativas en la necrosis histológica encontrada en los tumores phyllodes malignos. Las recidivas locales aparecieron en 8 pacientes (23,5%), principalmente durante los 2 primeros años de seguimiento. Conclusión. El principal objetivo fue conseguir mediante la cirugía (conservadora o mastectomía) márgenes de seguridad mayores de 1 cm, motivo por el que se sometió a algunas pacientes a reintervenciones posteriores. La histología agresiva en los tumores phyllodes malignos determinó en algunos casos la necesidad de realizar una mastectomía y la aplicación de radioterapia adyuvante posterior con el fin de lograr un mejor control local de la enfermedad(AU)

Aim. To describe the clinical and surgical management of phyllodes tumors in our center in the last 13 years, as well as local tumor control, according to tumoral grade. Material and method. We performed a retrospective study of all patients with a diagnosis of phyllodes tumor (N = 34) in the Pathology Department of Hospital Clínico San Carlos in Madrid between 1997 and 2010. The clinical and pathological factors that could influence recurrence and disease-free survival were analyzed. Results. The mean age of the patients at diagnosis was 41 years (± 13.3). Conservative surgery was initially performed in all patients (N = 34) and reoperation in 17 (50.0%). Mastectomies were performed in 7 patients: 5 simple mastectomies and 2 mastectomies with axillary lymphadenectomy. Three mastectomies were performed for benign phyllodes tumor and large tumor size (12%), with good cosmetic outcome, and 2 mastectomies were performed for malignant phyllodes tumors (33.3%). In the remaining 2 patients, mastectomy plus axillary lymphadenectomy was performed for a malignant phyllodes tumor with aggressive histology in one patient and for a recurrent, bulky, benign phyllodes tumor in the other. There was no evidence of disease in either of the 2 axillary dissections. In the univariate analysis, significant differences in histological necrosis were found in malignant phyllodes tumors. Local recurrences occurred in 8 patients (23.5%) mainly during the first 2 years of follow up. Conclusion. Our main objective was to achieve larger safety margins (of at least 1 cm) through surgery (mastectomy or conservative surgery), leading to reoperation in some patients. In histologically-aggressive malignant phyllodes tumors, mastectomy and adjuvant radiotherapy were required to achieve better disease control(AU)