From the Guidelines
The recommended treatment for a phyllode tumor is surgical excision with wide margins, as stated in the most recent and highest quality study 1, which involves removing the tumor along with at least 1 cm of surrounding normal breast tissue to ensure complete removal and reduce the risk of recurrence.
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 are suspicious findings 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 Recommendations
- Chemotherapy is generally not effective for phyllode tumors and is reserved for rare cases of metastatic disease 1.
- Following treatment, regular follow-up with clinical examinations and imaging is important to monitor for recurrence, as these tumors can return even years after initial treatment 1.
- The prognosis is generally excellent for benign phyllode tumors but more guarded for malignant variants 1.
Important Notes
- The management of phyllode tumors should be individualized and discussed in a multidisciplinary team setting, including breast cancer and sarcoma specialists 1.
- The role of immediate reconstruction should be carefully considered, and delayed reconstruction may be preferred in cases where postoperative radiotherapy is planned 1.
From the Research
Treatment Options for Phyllode Tumors
- The primary treatment for phyllode tumors is surgical resection, with the goal of achieving a wide margin to minimize the risk of local recurrence 2.
- For benign phyllode tumors, wide local excision with a 1-cm margin is recommended, while mastectomy is indicated for patients with large lesions 2.
- Adjuvant radiation therapy may be considered for patients with borderline or malignant phyllode tumors, as it has been shown to improve local recurrence-free survival (LRFS) in these cases 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.
Surgical Management
- Wide local excision (WLE) with a 1-cm margin or more is recommended for borderline and malignant phyllode tumors, while excisional biopsy may be sufficient for benign tumors 5.
- Mastectomy may be necessary for large or malignant tumors, or in cases where a wide margin cannot be achieved with WLE 2, 5.
- The choice of surgical procedure depends on the histologic grade and size of the tumor, as well as the patient's overall health and preferences 5.
Adjuvant Therapy
- Adjuvant radiation therapy has been shown to improve LRFS in patients with borderline and malignant phyllode tumors, particularly in those with margin-negative wide local excision 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.
- The use of adjuvant therapy should be individualized based on the patient's specific clinical and pathological characteristics 3, 4.