Breast phyllodes tumor: A review of literature and a single center retrospective series analysis

Spitaleri, Gianluca; Toesca, Antonio; Botteri, Edoardo; Bottiglieri, Luca; Rotmensz, Nicole; Boselli, Sabrina; Sangalli, Claudia; Catania, Chiara; Toffalorio, Francesca; Noberasco, Cristina; Delmonte, Angelo; Luini, Alberto; Veronesi, Paolo; Colleoni, Marco; Viale, Giuseppe; Zurrida, Stefano; Goldhirsch, Aron; Veronesi, Umberto; Pas, Tommaso De

doi:10.1016/j.critrevonc.2013.06.005

Cited by 176 publications

(185 citation statements)

References 76 publications

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“…8 Surgical recommendations are based on a clear and reproducible inverse association between widely clear margin status and recurrence rate for malignant phyllodes tumors. [9][10][11][12][13] The definition of negative margin varies widely across authors, with some advocating a clear margin of 41 cm. 14,15 Historically, incomplete excision of any phyllodes tumors has been correlated with local recurrences.…”

Section: Discussionmentioning

confidence: 99%

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

2016

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Breast phyllodes tumors are uncommon fibroepithelial neoplasms with a range of histologic features. Surgical excision is the primary management, but the need for excision to negative margins in benign and borderline phyllodes tumors is unclear. Here, we review the surgical management patterns and outcomes of 90 patients with benign and low-grade fibroepithelial lesions of the breast treated at our institution, including 19 borderline phyllodes tumors, 52 benign phyllodes tumors, and 19 representative neoplasms with overlapping features of fibroadenoma and benign phyllodes tumors, which were classified as 'fibroadenomas with phyllodal features'. In total, 52 (58%) had positive surgical margins on first excision, and of these 17 (33%) underwent re-excision to achieve negative margins. Residual tumor was identified in three (18%) re-excisions. Patients with fibroadenoma with phyllodal features were more likely to have a positive surgical margin than with benign phyllodes tumors or borderline phyllodes tumors (89 vs 49%, P = 0.0015), and were less likely to undergo re-excision for positive margins (12 vs 43%, P = 0.031). In total, there were three recurrences (3%), with one per fibroadenoma with phyllodal features, benign phyllodes tumor, and borderline phyllodes tumor. There was no statistically significant difference in recurrence rates between patients with positive or negative margins, or between patients with positive margin with or without re-excision. The extent of the positive margin did not predict recurrence. In conclusion, the recurrence rate of benign and low-grade fibroepithelial lesions is low and not associated with the original margin status. Patients with fibroadenomas with phyllodal features, benign phyllodes tumors, or selected borderline phyllodes tumors and positive margins on initial excision may be managed conservatively, with close follow-up and timely re-excision of any potential recurrence.

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Section: Discussionmentioning

confidence: 99%

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

2016

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“…Optimal surgery with negative margin is the key to reduce incidence of local recurrence. Though radiotherapy seems to be a viable option for reducing LR, its role should be tested [40] 1999-2010 172 Benign (39.6) BT ( prospectively in a randomized setting. Patients with borderline and malignant PTs with adverse histological features (margins <1 cm irrespective of other risk factors and in the case of wide margins tumors with additional risk factors like tumor size more than 2 cm, stromal overgrowth, mitosis ≥5/HPF, stromal atypia, tumor necrosis, and elderly age) should be encouraged to participate in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…In a review by Spitaleri et al, it has been shown that young age (<35 years) is a poor prognostic factor for all phyllodes-related events [25] 21 (44) 6 (28.6) [32] 19 (11) 11 (57.9) in both univariate and multivariate analyses. [40] Similarly, Pandey et al reported that women over the age of 35 years showed a decreased HR (HR = 0.7). [44] However, a majority of the studies indicate advance age (>50 years) as the indicator of LR as well as survival.…”

Section: Histological Classificationmentioning

confidence: 99%

“…[54] Similarly, the use of RT for tumors with high risk of local recurrence has been proposed by Bouhfa et al [55] In a retrospective analysis by Spitaleri et al, of nine patients who received adjuvant RT, none of them relapsed. [40] In two recent studies, adjuvant RT was associated with better local control. Belkacemi et al conducted a retrospective study as a part of Rare Cancer Network that included a total of 443 patients with PT.…”

Section: Efficacy Of Adjuvant Radiotherapymentioning

confidence: 99%

“…[8,9,24,25,[32][33][34][35][36][37][38][39][40] The incidence of local failure is higher when margin is positive rather than close. It is important to note that the definition of negative margins (i.e., 1 cm) has been arbitrarily derived from the retrospective studies.…”

Section: Histological Classificationmentioning

confidence: 99%

See 2 more Smart Citations

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

Wadasadawala¹,

Swain²,

Bajpai³

2016

Oncobiology and Targets

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Phyllodes tumor, previously known as cystosarcoma phyllodes, is a rare fibro-epithelial tumor of breast constituting <1% of all the breast tumors. It is classified into benign, borderline, and malignant subtypes depending upon the histological criteria defined by the World Health Organization and also has an independent prognostic significance. Accurate pretreatment histological diagnosis is important for the optimal management of phyllodes tumor so that low recurrence rates, improved survival, and optimal long-term cosmetic result can be achieved. Despite surgery being the standard of care, the best type of surgery for each histological type is yet to be defined. The higher rate of local recurrence after surgery alone in borderline and malignant phyllodes tumor raises the question regarding the need of adjuvant treatment, especially radiotherapy, which remains underutilized. The perspective of the current review is to provide the state-of-the-art management of phyllodes tumor of the breast and highlight the risk factors associated with recurrence.

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Neoplasms of the Breast

Rugo

Majure

Dragun

et al. 2017

Holland‐Frei Cancer Medicine

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Overview Breast cancer in women remains a major medical problem with significant public health and societal ramifications, including issues related to screening, risk factors, prevention, diagnosis, treatment, and survival following diagnosis. Major advances have markedly improved the understanding of clinical phenotypes, as well as the biologic pathways that drive tumor growth and resistance. This research has led to dramatic changes in treatment that have contributed to a significant reduction in breast cancer mortality over the last two decades, and is the basis of ongoing clinical research. Molecular profiling has provided insights into the heterogeneity of breast cancer subtypes; combining biology and tumor burden has allowed stratification of both risk and treatment to begin the process of individualizing screening, prevention, and treatment. As new information accumulates, new paradigms of management become the standard of care reflected in international guidelines. Our challenge is to apply new formation and treatment appropriately and effectively, and to understand both response and resistance. Information obtained from molecular, biologic, and pathologic investigations and clinical trials provides the major focus of this chapter.

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Breast phyllodes tumor: A review of literature and a single center retrospective series analysis

Abstract: Prognosis of phyllodes tumors is excellent. There are no convincing data to recommend any adjuvant treatment after surgery. Molecular characterization may well provide new clues to permit identification of active treatments for the rare poor prognosis cases.

Cited by 176 publications

References 76 publications

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

Neoplasms of the Breast

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