Phyllodes of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Phyllodes of the breast:
    • Is a rare lesion
  • Phyllodes 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
    • Local recurrence is lower with negative margins:
      • Historically, 1 cm margins have been recommended for malignant and borderline phyllodes tumors and continue to be recommended in the current 2024 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)
  • 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
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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