From the Guidelines
The primary treatment for Phyllodes tumors of the breast is wide local excision with at least a 1 cm margin of normal tissue, as this approach has been shown to be effective in reducing recurrence rates and improving outcomes 1.
Diagnosis
Phyllodes tumors are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors. They are classified as benign, borderline, or malignant based on histological features including stromal cellularity, mitotic activity, and tumor margins. Diagnosis of phyllodes tumors before excisional biopsy/lumpectomy is uncommon, and fine needle aspiration (FNA) cytology and even core needle biopsy are inadequate to reliably distinguish phyllodes tumors from fibroadenoma 1.
Treatment
The treatment of phyllodes tumors, including benign, borderline, and malignant subtypes, is with local surgical excision with tumor-free margins of 1 cm or greater. Lumpectomy or partial mastectomy is the preferred surgical therapy, and total mastectomy is necessary only if negative margins cannot be obtained with lumpectomy or partial mastectomy 1. Adjuvant radiotherapy has been demonstrated to improve local control, but not survival, in breast sarcomas and may be considered in high-risk cases of borderline phyllodes or malignant phyllodes tumors 1.
Follow-up and Prognosis
Regular follow-up with clinical examination and imaging is essential after treatment, typically every 6 months for 2 years, then annually. Patients should be educated about breast self-examination to detect recurrences early. The prognosis is generally good for benign and borderline tumors, with 5-year survival rates exceeding 90%, though malignant phyllodes tumors have a less favorable prognosis with 5-year survival rates of 50-60% 1.
Key Points
- Wide local excision with at least a 1 cm margin of normal tissue is the primary treatment for Phyllodes tumors of the breast.
- Adjuvant radiotherapy may be considered in high-risk cases of borderline phyllodes or malignant phyllodes tumors.
- Regular follow-up and patient education are essential for early detection of recurrences.
- The prognosis varies depending on the subtype of Phyllodes tumor, with benign and borderline tumors having a more favorable prognosis than malignant tumors.
From the Research
Diagnosis of Phyllodes Tumor
- Phyllodes tumors are rare sarcomas of the breast, and their diagnosis is typically based on histological classification into benign, indeterminate, and malignant types 2
- The diagnosis of phyllodes tumor is often made after surgical excision, and the tumor size can range from a few millimeters to several centimeters 3
Treatment of Phyllodes Tumor
- Surgical removal is the mainstay of treatment for phyllodes tumors, with the extent of surgery required (excision vs. mastectomy) depending on the tumor size and grade 2
- For malignant phyllodes tumors, mastectomy without axillary dissection is recommended as the standard treatment 4
- Breast-conserving surgery with a wide margin is preferred for non-malignant phyllodes tumors, with a margin of at least 1 cm recommended to minimize the risk of local recurrence 3
Role of Adjuvant Therapy
- The role of postoperative radiotherapy and chemotherapy in the treatment of phyllodes tumors is not fully established, but adjuvant radiotherapy may be beneficial in reducing the risk of local recurrence in patients with malignant tumors 4, 5
- Adjuvant radiation therapy has been shown to improve local recurrence-free survival in patients with borderline and malignant phyllodes tumors, particularly those treated with margin-negative breast-conserving surgery 5
Prognosis and Recurrence
- The prognosis for phyllodes tumors is generally good, with an overall survival rate of 88% at 5 years and 62% at 15 years 2
- Local recurrence is a significant concern, particularly in patients with malignant tumors or positive margins, and can be controlled with repeat excision or mastectomy in most cases 6
- Distant metastases are rare, but can occur, particularly in patients with stromal overgrowth or large tumor size 2, 6