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A Prospective, Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Malignant phyllodes tumors of the breast are unusual neoplasms, with an incidence of approximately 500 cases annually in the United States. Published local recurrence rates after margin-negative breast-conserving resections of borderline malignant and malignant phyllodes tumors are unacceptably high, at 24 and 20%, respectively. It is uncertain whether radiotherapy after resection of phyllodes tumors is beneficial.

Methods

We prospectively enrolled patients who were treated with a margin-negative breast-conserving resection of borderline malignant or malignant phyllodes tumors to adjuvant radiotherapy. The primary endpoint was local recurrence.

Results

Forty-six women were treated at 30 different institutions. The mean patient age was 49 years (range, 18–76 years). Thirty patients (65%) had malignant phyllodes tumors; the rest were borderline malignant. The mean tumor diameter was 3.7 cm (range, .8–11 cm). Eighteen patients had a negative margin on the first excision. The median size of the negative margin was .35 cm (range, <.1–2 cm). Twenty-eight patients underwent a re-excision because of positive margins in the initial resection. Two patients died of metastatic phyllodes tumor. During a median follow-up of 56 months (range, 12–129 months), none of the 46 patients developed a local recurrence (local recurrence rate, 0%; 95% confidence interval, 0–8).

Conclusions

Margin-negative resection combined with adjuvant radiotherapy is very effective therapy for local control of borderline and malignant phyllodes tumors. The local recurrence rate with adjuvant radiotherapy was significantly less than that observed in reported patients treated with margin-negative resection alone.

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Acknowledgment

We acknowledge the support of medical librarian Cindy Stewart, clinical research associates Megan Patey, Cynara Nayar and Denise Machado from the Clinical Research Office of the Norris Cotton Cancer Center, and Elizabeth Bankert and the staff of the Dartmouth Committee for the Protection of Human Subjects. The authors have no commercial interests in this work. The authors did not receive external funding for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Richard J. Barth Jr. MD

  2. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Wendy A. Wells MD

  3. Department of Radiation Oncology, Randolph Cancer Center, Asheboro, NC, USA

    Sandra E. Mitchell MD

  4. Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA

    Bernard F. Cole PhD

Authors
  1. Richard J. Barth Jr. MD
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  2. Wendy A. Wells MD
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  3. Sandra E. Mitchell MD
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  4. Bernard F. Cole PhD
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Corresponding author

Correspondence to Richard J. Barth Jr. MD.

Appendix

Appendix

Participating institutions (and number of patients treated): Dartmouth-Hitchcock Medical Center, Lebanon, NH (13); U. of Massachusetts Medical Center, Worcester MA (4); Elliot Hospital, Manchester, NH (3). The following institutions each treated one patient: Jordan Hospital, Plymouth, MA; St. Francis Hospital, Hartford, CT; Central Maine Medical Center, Lewiston, ME; Maine Medical Center, Scarborough, ME; Lahey Clinic, Burlington, MA; Attleboro Surgical Associates, Attleboro, MA; Nashua Regional Cancer Center, Nashua, NH; Moore Regional Hospital, Pinehurst, NC; Hartford Hospital, Hartford, CT; Finger Lakes Radiation Oncology, Clifton Springs, NY; Ohio State University, Columbus, OH; 21st Century Oncology, Fort Myers, FL; Redwood Regional Oncology Center, Santa Rosa, CA; Northeast Regional Radiation Oncology Network, Manchester, CT; Holy Name Hospital, Teaneck, NJ; Exeter Hospital, Exeter, NH; Greater Baltimore Medical Center, Baltimore, MD; Carson Tahoe Regional Healthcare, Carson City, NV; Baptist Hospital East, Louisville, KY; St. Agnes Medical Center, Fresno, CA; Cancer Care of Maine, Bangor, ME; Radiant Care, Lacey, WA; Oncologics Inc., Lafayette, LA; Memorial Medical Center, Springfield, IL; McLeod Health, Florence, SC; Virginia Commonwealth University, Richmond, VA.

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Barth, R.J., Wells, W.A., Mitchell, S.E. et al. A Prospective, Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors. Ann Surg Oncol 16, 2288–2294 (2009). https://doi.org/10.1245/s10434-009-0489-2

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