Phyllodes Tumors of the Breast

  • Phyllodes tumors of the breast:
    • Are rare lesions
  • Phyllodes tumors are classified into three groups: 
    • Benign
    • Borderline
    • Malignant
  • Borderline and malignant phyllodes:
    • Have a higher incidence of local recurrence:
      • Therefore, historically management was:
        • A mastectomy without nodal assessment
      • Recently, more patients are undergoing lumpectomy for this lesion
      • Researchers believe that local recurrence rates:
        • Are similar for borderline and malignant phyllodes tumors:
      •  
      • Historically:
        • 1 cm margins have been recommended for malignant and borderline phyllodes tumors:
          • And continue to be recommended in the current 2020 NCCN guidelines
        • The guidelines however note that while narrow margins are associated with an increased risk for local recurrence:
          • They are not an absolute indication for mastectomy
      • Newer data may suggest a smaller margin is adequate:
        • Spanheimer et al.:
          • Identified local recurrences in 16% of 71 patients with borderline or malignant phyllodes tumors undergoing:
            • Breast-conserving surgery
          • Some of these patients had a positive or close (< 1 mm) margin
          • When the subset of patients with a margin > 1 mm was considered:
            • The local recurrence rate was 12%
      • In addition, radiation may play a role in decreasing the risk of local recurrence:
        • In a prospective, multi-institutional study, 46 patients (30 with malignant phyllodes tumors and 16 with borderline phyllodes tumors) underwent margin-negative resections followed by radiation therapy:
          • Eight of these patients had margins < 2 mm
          • After 10 years of observation for all patients:
            • None had developed a local recurrence
        • In another study using data from the National Cancer Database, Gnerlich et al:
          • Showed that adjuvant radiation therapy decreased the risk of local recurrence after resection of phyllodes tumors by:
            • More than half (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.19–0.95).4
  • References
    • Tan, BY, Acs, G, Apple, SK, et al. Phyllodes tumor of the breast: a consensus review. Histopathology. 2016;68(1):5-21.
    • Spanheimer P, Murray M, Zabor E, et al. Long term outcomes after surgical treatment of malignant/borderline phyllodes tumors of the breast. Ann Surg Oncol. 2019;26(7):2136-2143.
    • Barth R, Wells W, Mitchell S, Cole B. A prospective, multi-institutional study of adjuvant radiation therapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16(8):2288-2294.
    • Gnerlich J, Williams R, Yao K, Jaskowiak N, Kulkarni S. Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Database 1998–2009. Ann Surg Oncol. 2014;21(4):1222-1230

#Arrangoiz #BreastSurgeon #CancerSurgeon #Teacher #SurgicalOncologist #BreastCancer #PhylloidesTumors #Miami #CASO #CenterforAdvancedSurgicalOncology

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