From the Guidelines
Surgical excision with wide margins is the primary treatment for phyllodes breast cancer, with the goal of achieving at least 1 cm margins around the tumor to prevent recurrence. The management of phyllodes breast cancer involves a multidisciplinary approach, taking into account the tumor's size, grade, and margins. According to the most recent guidelines 1, the standard surgical treatment remains wide excision with clear margins, and either breast-conservative surgery (BCS) or mastectomy can be undertaken.
Key Considerations
- For large malignant phyllodes tumors, breast conservation may not be possible, and mastectomy may be necessary 1.
- Axillary lymph node dissection is typically not required as phyllodes tumors rarely spread to lymph nodes 1.
- Adjuvant radiotherapy has been demonstrated to improve local control, but not survival, in breast sarcomas, and may be considered in high-risk cases, such as large tumors, close or positive margins, multifocal, or recurrent disease 1.
- Chemotherapy is generally reserved for metastatic disease and has limited efficacy, while hormonal therapy is not effective as phyllodes tumors typically lack hormone receptors 1.
Follow-up and Prognosis
- Regular follow-up with clinical examinations and imaging is essential, typically every 3-6 months for the first 2 years, then annually, as recurrences are most common within this timeframe 1.
- Prognosis varies based on histological grade, with benign phyllodes having excellent outcomes while malignant variants carry higher recurrence and metastatic potential 1.
From the Research
Management of Phyllodes Breast Cancer
The management of Phyllodes breast cancer involves several approaches, including:
- Surgical treatment: The mainstay of treatment for Phyllodes tumors is surgical excision with a safe surgical margin 2, 3, 4, 5
- Breast-conserving surgery: This is a preferred option for benign and borderline Phyllodes tumors, with a low risk of local recurrence 3, 5
- Mastectomy: This may be considered for malignant Phyllodes tumors or in cases of local tumor recurrence 2, 3
- Adjuvant radiation therapy: This may be beneficial for patients with borderline or malignant Phyllodes tumors, particularly those with margin-negative wide local excision 6
- Adjuvant treatments: The role of adjuvant treatments, such as chemotherapy and hormone therapy, is unclear and should be considered on a case-by-case basis 3
Predictors of Recurrence
Several factors have been identified as predictors of recurrence in Phyllodes breast cancer, including:
- Tumor size: Larger tumors are associated with a higher risk of recurrence 2, 3, 4
- Tumor grade: Higher-grade tumors are associated with a higher risk of recurrence 2, 3
- Mitotic rate: A higher mitotic rate is associated with a higher risk of recurrence 2, 4
- Stromal overgrowth: This is a significant predictor of recurrence and survival 2
- Margin status: While margin width is not a significant predictor of recurrence, positive margins are associated with a higher risk of recurrence 4
Follow-up and Surveillance
Regular clinical and imaging follow-up is essential for patients with Phyllodes breast cancer, particularly during the first 2 years after initial excision 5. This allows for early detection of recurrence and prompt treatment.