Metastatic and Malignant Phyllodes Tumors of the Breast: An Update for Current Management

Abstract

Metastatic, malignant phyllodes tumor (PT) of the breast is a rare and aggressive neoplasm. Currently, there is no agreed upon consensus as to best management practices. A systematic review of literature was conducted investigating surgical, chemotherapeutic, and radiotherapeutic management for metastatic PT. Databases employed to identify articles included Embase, PubMed, and SAGE Journals. Diagnosis of metastatic PT has been of significant difficulty to radiologists as it is often confused with fibroadenomas. Surgically, metastatectomy has been correlated with increased overall survival (of 25.9 versus 9.9 months; P = .01). Radiotherapy has often been associated with palliation and pain control in metastatic, malignant neoplasia. However, one study showed that in malignant PT, radiation was associated with significantly lower rates of local recurrence (OR: 0.048 versus 0.209). Anthracycline containing chemotherapy regimens has been associated with improved overall survival (22.4 months versus 13.2 months; P = .040). Further research must be conducted into this rare malignancy to elucidate accurate diagnosis and care for patients with advanced metastatic or malignant phyllodes tumors.

Resección de Tumor Phyllodes con Reconstrucción Inmediata de la Mama, Cirugía Oncoplástica: Reporte de Caso y Revisión de la Literatura

“…De acuerdo con las directrices de la Red Nacional Integral del Cáncer (NCCN), el tratamiento quirúrgico recomendado para los tumores filoides malignos consiste en una escisión quirúrgica completa con márgenes de al menos 1 cm, sin cirugía axilar. (8,10,13,16) Existe evidencia que sugiere que los márgenes quirúrgicos tienen un impacto en el pág. 11344 riesgo de recurrencia.…”

“…Estudios previos han informado que la quimioterapia adyuvante no mejora la supervivencia libre de metástasis. Las tasas de supervivencia a 5 años reportadas para los tumores filoides malignos oscilan entre el 54% y el 82%, llegando en ocasiones hasta el 95,7% (1,11,16,18).…”

“…El papel de la radioterapia y la quimioterapia en el tratamiento de los tumores filoides sigue siendo incierto. (1,11,16,18). Es fundamental reconocer que la reconstrucción mamaria debe considerarse como un componente primordial en el proceso de tratamiento.…”

“…In the case of benign phyllodes tumors, a narrow negative margin may be optimal, without the need to meet the traditional excision margin of ≥10 mm (7,9). The role of radiotherapy and chemotherapy in the treatment of phyllodes tumors remains uncertain (1,11,16,18). It is essential to recognize that breast reconstruction should be considered as a primary component in the treatment process.…”