Malignant and borderline phyllodes tumor of breast treated with a multi-modality approach in a tertiary cancer care centre in North India

Abstract

Background:Phyllodes tumor (PT) of the breast can be categorized into benign, borderline and malignant subgroups depending on various histopathological factors. Although malignant PTs may be indolent and controlled by local excision, they frequently show local and distant relapses. Literature reveals local recurrence to be the predominant pattern of failure and thus emphasizes the importance of adjuvant radiation in these tumors. The role of systemic chemotherapy has remained doubtful.Materials and Methods:We have analyzed details of all patients of PT (n = 33) treated with adjuvant multi-modality approach in our institute since 1994–2009. The demographic data, treatment details, recurrence patterns and salvage treatment options were documented.Results:All patients received adjuvant radiation. Seven patients received adjuvant chemotherapy. The mean survival of the entire cohort was 150.618 months. There was a trend for better overall survival with borderline grade (193.6 vs. 160.2 months; P = 0.08, log rank). The disease free survival (DFS) favored borderline grade (193.6 months vs. 82.9 months for high grade; P = 0.02, log rank). The DFS was significantly better in tumors having negative margins on postoperative histopathological examination (DFS rate at 5 years being 100% vs. 69.2% for positive or close margins; P = 0.015). The mode of surgery did not have any impact on survival.Conclusion:Adjuvant Radiation should be discussed taking into account surgical margins, size and various pathological factors of the primary. Adjuvant radiation may be utilized in high risk patients to enhance loco-regional control. Systemic chemotherapy is an option, worth exploring, in cases of systemic failure.

Huge borderline phyllodes breast tumor with repeated recurrences and progression toward more malignant phenotype: a case report and literature review

“…In the past, surgeons generally chose simple or radical mastectomy for borderline and malignant PTs. 23 The study by Hasssouna et al 24 revealed that radical surgery really improved the survival and decreased the rate of local recurrence. In addition, another study by Barth et al 25 showed that the prognosis of wide local excision combined with postoperative radiotherapy was equivalent to that of radical surgery.…”

Phyllodes Tumors of the Breast (the Egyptian Experience)

“…The sensitivity of core needle biopsy (CNB) in diagnosing PTs is 63% while that with (FNAC) is 40% [37]. Wide Local Excision (WLE), with a margin of at least 1 cm is the surgery of choice (S. [21]). Re-excision is indicated when necessary to reduce recurrence rates following excision with inadequate margins.…”

“…However, available data indicate that RT will reduce recurrence after breast conserving resection for borderline or malignant PTs. There is less agreement about the role of adjuvant RT when wide margins ⩾ 1 cm can be obtained (S. [21]). Adjuvant chemotherapy should be administered only for a minority of patients with large, high-risk or recurrent malignant tumors, and only after a thorough discussion about the risks and benefits of treatment ( [21]).…”

“…There is less agreement about the role of adjuvant RT when wide margins ⩾ 1 cm can be obtained (S. [21]). Adjuvant chemotherapy should be administered only for a minority of patients with large, high-risk or recurrent malignant tumors, and only after a thorough discussion about the risks and benefits of treatment ( [21]). Hormone therapy is not effective for PTs despite the presence of positive hormone receptors in the epithelial component of some of these tumors [34].The survival rate for malignant PTs is reported as approximately 60-80% at 5 years [32].…”

Olaratumab administered in two cases of phyllodes tumour of the breast: end of the beginning?

“…Liposomal doxorubicin in combination with bevacizumab has been reported in one case 17. In an Indian report, epirubicin with ifosfamide was administered to four patients 18. Due to the rarity of the disease, there is no consensus on the systemic treatment of these tumours and patients are treated according to National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) sarcoma guidelines 8 9.…”