Successful Treatment of a Locally Recurrent and Metastatic Malignant Phyllodes Tumor with Accelerated Radiotherapy and Nab-Paclitaxel, Cisplatin, and Liposomal Doxorubicin Chemotherapy

Abstract

Phyllodes tumors are rare breast lesions of fibroepithelial origin. Malignant transformation with metastases is linked with poor prognosis. We present a case of a 62-year-old woman with a recurrent malignant phyllodes tumor of the breast and lung metastases. The patient was originally presented with a borderline phyllodes tumor (7.4 cm) of the left breast, treated with wide local excision. A year later, the patient returned with palpable left breast masses. On PET-CT, increased uptake of <sup>18</sup>F-FDG by large breast tumors was evident. A right lung lesion of metastatic origin was also present. A simple left breast mastectomy was performed. Histopathological report described 2 malignant phyllodes tumors (7 cm and 6.5 cm). One month later, during the CT simulation for radiotherapy planning, encysted fluid in the chest wall and 2 additional pulmonary lesions of the right lung were identified, confirming progressive lung metastatic disease. Both the chest wall and the regional lymph node area were irradiated with hypofractionated and accelerated radiotherapy. Biweekly chemotherapy with albumin-bound paclitaxel, cisplatin, and liposomal doxorubicin was also prescribed at the start of radiotherapy for 12 cycles. At the end of chemotherapy, complete regression of lung metastases was achieved, and there was no evidence of local recurrence. Within 2 years of follow-up, the patient is free of disease and treatment-related toxicities. Accelerated hypofractionated radiotherapy is effective in the locoregional control of malignant phyllodes tumors. The combination of cisplatin with nab-paclitaxel and liposomal doxorubicin chemotherapy has acceptable toxicity and is highly effective in eradicating metastatic lesions.

Malignant Phyllodes Tumor of the Breast: Case Report

“…PT is a rare form of breast tumor. It accounts for about 2.5% of fibroepithelial tumors of the breast 2 , with an incidence of 2.1 per million women 3 . PT of the breast usually manifests as a painless rapidly growing unifocal mass that is most commonly located in the LUQ, as occurred in the case report 4 .…”

“…The treatment of choice for these cases is SR with a 1.0 cm margin and without axillary node dissection [1][2][3][4][5] . According to a systematic review with meta-analysis conducted by Toussaint et al, the width of the safety margin is related to lower local recurrence, mainly in malignant PT, although a significant difference in the occurrence of metastases was not found 6 .…”

“…They are classically divided into benign, borderline or malignant 2 . Patients with PT usually present a fast-growing palpable mass with features similar to fibroadenoma on ultrasonography (US) 3 . Local recurrence of malignant PT is approximately 19-40%, and the mean period of recurrence is 1-39 months (mean: 20.3 months).…”

“…Adjuvant radiotherapy has been shown to increase disease-free survival in these cases. However, available data on increased overall survival in the literature remain inconclusive 3 . The aim of this study was to report a case of malignant PT of the breast.…”

Malignant phyllodes tumor of the breast with metastases to the lungs: A case report and literature review

“…Recent literature reports that 10%-15% of PTs are malignant and approximately 9%-27% of patients with malignant phyllodes tumor have metastasis to distant organs with spreading hematogenously to most frequent sites as lungs, bones, brain, and liver [6] . Recurrence or metastasis of breast PTs predicts a shorter survival time, less than 2 years after diagnosis [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] .…”