Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 10, pp 3199–3205 | Cite as

Current Trends in the Management of Phyllodes Tumors of the Breast

  • Taiwo Adesoye
  • Heather B. Neuman
  • Lee G. Wilke
  • Jessica R. Schumacher
  • Jennifer Steiman
  • Caprice C. Greenberg
Breast Oncology

Abstract

Introduction

National Comprehensive Cancer Network (NCCN) guidelines recommend wide excision without axillary staging to treat phyllodes tumors of the breast. Without prospective trials to guide management, NCCN also recommends consideration of radiation therapy (XRT). We describe current patterns of care for the multidisciplinary management of phyllodes tumors.

Methods

Using Surveillance, Epidemiology, and End Results Program (SEER) data, we identified women diagnosed with phyllodes tumors between 2000 and 2012 who underwent surgical therapy. Trends in breast-conserving surgery (BCS), nodal sampling, and XRT were assessed using the Cochrane–Armitage test. Multivariable logistic regression was used to identify factors associated with treatment.

Results

Of 1238 patients, 56.9 % underwent BCS and 23.6 % underwent nodal sampling (10.5 % after BCS vs. 40.9 % after mastectomy). After surgery, 15.4 % received adjuvant XRT (BCS 12.9 %, and mastectomy 18.8 %). XRT utilization increased significantly over the study period (BCS, p = < 0.0001; mastectomy, p = 0.0003), while nodal sampling did not change significantly. Women were more likely to receive mastectomy if they were older or had larger tumors. Nodal sampling was also associated with older age, larger tumor size, and receipt of mastectomy. Receipt of XRT was associated with later year of diagnosis, larger tumors, and nodal assessment.

Conclusion

Over time, an increasing number of women received XRT after surgical management of phyllodes tumor, and one in four women underwent nodal sampling. While some of this practice can be attributed to concern about more advanced disease in the absence of strong data, there may be an educational gap regarding current guidelines and appropriate management.

Keywords

National Comprehensive Cancer Network National Comprehensive Cancer Network Wide Excision Phyllode Tumor National Cancer Data Base 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Financial Support

Taiwo Adesoye receives support from the University of Wisconsin Surgical Oncology Research Training Program (T32 CA090217), and Heather B. Neuman is supported through the Building Interdisciplinary Research Careers in Women’s Health Scholar Program (NIH K12 HD055894).

Disclosures

None.

References

  1. 1.
    Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Barth RJ, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16(8):2288–94.CrossRefPubMedGoogle Scholar
  3. 3.
    Lee AHS. Recent developments in the histological diagnosis of spindle cell carcinoma, fibromatosis and phyllodes tumour of the breast: spindle cell and fibroepithelial lesions. Histopathology. 2007;52(1):45–57.CrossRefGoogle Scholar
  4. 4.
    Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993;71:3020–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. 2001;77(909):428–35.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Salvadori B, Cusumano F, Del Bo R, et al. Surgical treatment of phyllodes tumors of the breast. Cancer. 1989;63:2532–6.CrossRefPubMedGoogle Scholar
  7. 7.
    National Comprehensive Cancer Network. Phyllodes Tumor (Version 1.2016). Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 25 Jan 2016.
  8. 8.
    National Cancer Institute. Surveillance Epidemiology and End Results (SEER) program. Available at: http://seer.cancer.gov/about/overview. Accessed 1 Jan 2016.
  9. 9.
    Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006;107(9):2127–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Chaney AW, Pollack A, Mcneese MD, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000;89(7):1502–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Guerrero MA, Ballard BR, Grau AM. Malignant phyllodes tumor of the breast: review of the literature and case report of stromal overgrowth. Surg Oncol. 2003;12:27–37.CrossRefPubMedGoogle Scholar
  12. 12.
    Belkacémi Y, Bousquet G, Marsiglia H, et al. Phyllodes tumor of the breast. Int J Radiat Oncol. 2008;70(2):492–500.CrossRefGoogle Scholar
  13. 13.
    Barrio AV, Clark BD, Goldberg JI, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14(10):2961–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Gnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998–2009. Ann Surg Oncol. 2014;21(4):1222–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Pilewskie M, Karsten M, Radosa J, Eaton A, King TA. Is sentinel lymph node biopsy indicated at completion mastectomy for ductal carcinoma in situ? Ann Surg Oncol. 2016;23(7):2229–34.CrossRefPubMedGoogle Scholar
  16. 16.
    National Comprehensive Cancer Network. Invasive Breast Cancer (Version 1.2016). Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 25 Jan 2016.
  17. 17.
    Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol. 2001;27(8):723–30.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Taiwo Adesoye
    • 1
  • Heather B. Neuman
    • 1
    • 2
  • Lee G. Wilke
    • 2
  • Jessica R. Schumacher
    • 1
  • Jennifer Steiman
    • 2
  • Caprice C. Greenberg
    • 1
    • 2
  1. 1.Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of SurgeryUniversity of Wisconsin Hospitals and ClinicsMadisonUSA
  2. 2.Division of Surgical Oncology, Department of SurgeryUniversity of Wisconsin Hospitals and ClinicsMadisonUSA

Personalised recommendations