Phyllodes tumors of the breast: Adjuvant radiation therapy revisited

Boutrus, Rimoun; Khair, Sandy; Abdelazim, Yasser; Nasr, Sarah S.; Ibraheem, Maher H.; Farahat, Ahmed; Sebaie, Medhat El

doi:10.1016/j.breast.2021.03.013

Cited by 19 publications

(20 citation statements)

References 17 publications

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“…The NCCN recommends consideration of adjuvant radiotherapy for recurrent PT, and a recent study reported significantly improved local recurrence-free survival in patients with borderline and malignant PT treated with adjuvant radiation following wide local excision to negative margins. 18 Our study is limited by small sample size. Although all available data were included, dating back to the inception of our institutional pathology database, PT has a low incidence.…”

Section: Discussionmentioning

confidence: 91%

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Race-Related Differences in the Clinical Presentation and Histopathologic Features of Phyllodes Tumor

Johnson

Mohamed

Hassan

et al. 2021

The American Surgeon

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Background Phyllodes tumor (PT) is a rare fibroepithelial lesion of the breast with variable malignant potential. Black women have a higher incidence of a related benign tumor, fibroadenoma, but there are limited epidemiological data on PT. The aim of our study was to evaluate race-related differences in the clinicopathologic features and outcomes of PT. Methods Our institutional pathology database was queried for breast specimen reports from 01/2009 to 10/2019 to identify patients with a pathologic diagnosis of PT. Chart review and detailed slide review were performed to obtain clinical and histopathologic variables, respectively. Results Among twelve patients, two had malignant PT, three had borderline PT, and seven had benign PT. All patients with malignant and borderline PT were black, compared with 29% of those with benign PT. There were no apparent race-related differences in specific histopathologic features among black vs. non-black women with benign PT. Malignant and borderline PT were relatively larger than benign PT, with mean tumor sizes of 9.0 cm (standard deviation [SD] 4.7 cm), 12.2 cm (SD 9.4 cm), and 5.4 cm (SD 5.8 cm), respectively. Two women had a local recurrence, both of whom were black. Discussion In this single-institution retrospective study, we observed disproportionate rates of aggressive histopathologic features and disparate outcomes among black women with PT. A multi-institutional PT registry would facilitate improved knowledge about race-related differences in the presentation and outcomes of this rare tumor.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Race-Related Differences in the Clinical Presentation and Histopathologic Features of Phyllodes Tumor

Johnson

Mohamed

Hassan

et al. 2021

The American Surgeon

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“…Zeng et al showed that adjuvant RT for borderline/malignant PT decreased the LR rate in patients undergoing BCS (50). However, Boutrus et al showed that RT was not suitable for BPT but may improve local recurrence free survival for borderline/malignant PT (52). We did not assess RT as a risk factor due to the limited data and more data are needed for further exploration of this issue.…”

Section: Respectively (P=0397) Second International Consensusmentioning

confidence: 97%

Surgical management and prognosis of phyllodes tumors of the breast

Zhong

Zheng

et al. 2022

Gland Surg

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Background: Regardless of histological grade, phyllodes tumors (PTs) exhibit the potential of local recurrence. The National Comprehensive Cancer Network (NCCN) recommends wide local excision (WLE) with a 1 cm margin or more for borderline/malignant PTs but excisional biopsy for benign PTs. However, the treatment of benign PTs remains controversial and the clinicopathologic risk factors for the local recurrence is still unclear. Methods: We retrospectively analyzed 238 patients with PTs who underwent surgery at the Chinese PLA General Hospital from January 1, 2006 and April 30, 2020. We stratified our analysis according to histologic grade and explored the clinicopathologic factors to influence local recurrence (LR), including age, histologic grade, history of fibroadenoma, type of surgery [vacuum-assisted biopsy system (VABS), local excision (LE), wide local excision (WLE) and mastectomy].Results: All 238 cases were categorized as benign (171, 71.8%), borderline (38, 16.0%), or malignant (29, 12.2%). The median follow-up was 50.2 months. In multivariate analysis, histologic grade (P<0.01) and history of fibroadenoma (P<0.01) were independent prognostic factors for LR. No difference existed in the recurrence rate of BPT treated with different surgical procedures (P=0.397), whereas a higher recurrence rate was found in VABS and LE subgroups than in WLE and mastectomy subgroups for borderline/ malignant tumors (P<0.01).Conclusions: No association found between surgical modalities and LR rate for BPT. We suggested a "wait-and-watch" policy for patients with unexpected benign subtypes, instead of unnecessary re-excision. In addition, VABS or LE can be treated for BPT with small mass, whereas WLE or even mastectomy should be conducted for borderline/malignant PTs with large mass.

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“…In the absence of a standard of care regarding adjuvant treatment, surgical resection is the cornerstone of their treatment. Regardless, the therapy should be multidisciplinary and possibly managed by a specialized center [156][157][158].…”

Section: Margin Acceptability In the Case Of Non-epithelial Malignanciesmentioning

confidence: 99%

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Breast-conserving surgery (BCS) experienced a significant surge during the last decades due to the increase of early breast cancer detection. Central to the discussion is margin adequacy which represents one of the most significant predictive factors for local relapse. This paper aims to shed light on the problem of margins in breast surgery. Mechanism: We performed a systematic narrative review of the literature by conducting a search using Medline/PubMed, Scopus, and Embase. The following keywords were considered: "breast-conserving surgery" AND "margins"/"margin". Findings in Brief: In the case of invasive breast cancer, "no ink on tumor" can be considered an adequate margin, while for ductal carcinoma in situ (DCIS), a distance of 2 mm from tumor should be obtained. Many novel tools have been developed based both on the latest radiological imaging techniques and on the tissue expression of certain markers, with the aim of precise navigation of tumor excision and intraoperative evaluation of cavity excision margins. Oncoplastic surgery can be considered oncologically safe while improving the cosmetic outcome and patients' quality of life. The appropriate use of adjuvant treatments in the context of a multidisciplinary and personalized management of breast cancer is the only means to omit a second intervention in some carefully selected cases. Conclusions: Debate still exists concerning the definition of adequate clear margin following BCS for DCIS. Further studies are required to better assess multimodal treatment approaches in this condition.

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Phyllodes tumors of the breast: Adjuvant radiation therapy revisited

Cited by 19 publications

References 17 publications

Race-Related Differences in the Clinical Presentation and Histopathologic Features of Phyllodes Tumor

Race-Related Differences in the Clinical Presentation and Histopathologic Features of Phyllodes Tumor

Surgical management and prognosis of phyllodes tumors of the breast

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

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