From the Guidelines
The recommended treatment for a phyllode tumor is surgical excision with wide margins, typically involving removal of the tumor along with at least 1 cm of surrounding normal breast tissue to ensure complete removal and reduce the risk of recurrence, as supported by the most recent guidelines 1.
Key Considerations
- The surgical approach depends on the tumor size, location, and histological classification (benign, borderline, or malignant) 1.
- For smaller tumors, a wide local excision or lumpectomy may be sufficient, while larger tumors or those with malignant features might require a mastectomy 1.
- Unlike other breast cancers, phyllode tumors rarely spread to lymph nodes, so lymph node removal is not routinely performed unless there is clinical evidence of involvement 1.
- Radiation therapy may be recommended after surgery for borderline or malignant phyllode tumors to reduce local recurrence risk, particularly if adequate surgical margins were difficult to achieve 1.
Additional Treatment Options
- Chemotherapy is generally not effective for phyllode tumors and is reserved for rare cases of metastatic disease 1.
- Regular follow-up imaging is important after treatment, as phyllode tumors have a recurrence rate of 10-40% depending on their classification 1.
- The treatment approach is guided by the understanding that phyllode tumors grow from the stromal (connective tissue) component of the breast rather than the ductal or lobular elements that give rise to most breast cancers 1.
Recent Guidelines
- The UK guidelines for the management of soft tissue sarcomas recommend close collaboration between a breast cancer MDT and a sarcoma MDT for the management of patients with breast sarcomas, including phyllode tumors 1.
- The guidelines also recommend consideration of adjuvant radiation treatment for large tumors, close or positive margins, multifocal, or recurrent disease, irrespective of the surgery type (BCS versus mastectomy) 1.
From the Research
Treatment Options for Phyllode Tumors
- Surgical resection is the cornerstone of treatment for phyllode tumors, with primary excision or reexcision with a 1-cm margin recommended 2
- Mastectomy is indicated for patients with large lesions 2
- Adjuvant radiation therapy may be considered for patients with borderline or malignant phyllodes tumors, as it has been shown to improve local recurrence-free survival (LRFS) 3
- Chemotherapy may be used in cases of metastatic disease, with a combination of cisplatin, nab-paclitaxel, and liposomal doxorubicin showing promise in eradicating metastatic lesions 4
Factors Affecting Treatment Outcomes
- Local recurrence is correlated with excision margins, with positive margins or margins less than 1 cm increasing the risk of recurrence 2
- Tumor grade and size do not appear to affect local recurrence rates 2
- Younger age and malignant phyllodes tumor are associated with a higher risk of recurrence 5
Surgical Management
- Wide local excision is the most common surgical procedure for phyllodes tumors, with mastectomy reserved for cases where a wide local excision is not possible 5
- Simple mastectomy may be recommended for borderline or malignant cases, especially when it is difficult to achieve reliable negative margins 6
Adjuvant Therapy
- Adjuvant radiation therapy may be beneficial for patients with borderline or malignant phyllodes tumors, particularly those with close or positive margins 3
- Chemotherapy is not generally recommended as a first-line treatment for phyllodes tumors, but may be considered in cases of metastatic disease 6, 4