Noorie Choi1, Kyubo Kim2, Kyung Hwan Shin3, Yumi Kim4, Hyeong-Gon Moon4, Won Park5, Doo Ho Choi6, Su Ssan Kim7, Seung Do Ahn7, Tae Hyun Kim8, Mison Chun9, Yong Bae Kim10, Suzy Kim11, Byung Ock Choi12, Jin Hee Kim13. 1. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea. 3. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. shin.kyunghwan@gmail.com. 4. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 5. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wonro.park@samsung.com. 6. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 7. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 8. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea. 9. Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea. 10. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. 11. Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. 12. Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. 13. Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Abstract
PURPOSE: To identify risk factors for local recurrence (LR) and investigate roles of adjuvant local therapy for malignant and borderline phyllodes tumors of the breast. METHODS: From 1981 to 2014, 362 patients with malignant (n = 235) and borderline (n = 127) phyllodes tumors were treated by breast-conserving surgery (BCS) or total mastectomy (TM) at 10 centers. Thirty-one patients received adjuvant radiation therapy (RT), and those who received adjuvant chemotherapy were excluded from the study. RESULTS: Median follow-up was 5 years. LR developed in 60 (16.6%) patients. Regional recurrence occurred in 2 (0.6%) patients and distant metastasis (DM) developed in 19 (5.2%) patients. Patients receiving BCS (p = 0.025) and those not undergoing adjuvant RT (p = 0.041) showed higher LR rates. For malignant subtypes, local control (LC) rates at 5 years for BCS alone, BCS with adjuvant RT, TM alone, and TM with adjuvant RT were 80.7, 93.3, 92.4, and 100%, respectively (p = 0.033). Multivariate analyses revealed BCS alone, tumor size ≥ 5 cm, and positive margins as independent risk factors for LR. Margin-positive BCS alone showed poorest LC regardless of tumor size (62.5%, p = 0.007). For margin-negative BCS alone, 5-year LC rates for tumors ≥ 5 cm versus those < 5 cm were 71.8% versus 89.5% (p = 0.012). For borderline subtypes, only positive margins (p = 0.044) independently increased the risk of LR. DM developed exclusively in malignant subtypes and a prior LR event increased the risk of DM by sixfold (HR 6.2, 95% CI 1.6-16.1, p = 0.001). CONCLUSIONS: Malignant and borderline phyllodes tumors with positive margins after surgery have high LR rates. After treatment by margin-negative BCS alone, patients with large malignant phyllodes tumors ≥ 5 cm also have heightened risk of LR. Thus, such patients should be considered for additional local therapy.
PURPOSE: To identify risk factors for local recurrence (LR) and investigate roles of adjuvant local therapy for malignant and borderline phyllodestumors of the breast. METHODS: From 1981 to 2014, 362 patients with malignant (n = 235) and borderline (n = 127) phyllodestumors were treated by breast-conserving surgery (BCS) or total mastectomy (TM) at 10 centers. Thirty-one patients received adjuvant radiation therapy (RT), and those who received adjuvant chemotherapy were excluded from the study. RESULTS: Median follow-up was 5 years. LR developed in 60 (16.6%) patients. Regional recurrence occurred in 2 (0.6%) patients and distant metastasis (DM) developed in 19 (5.2%) patients. Patients receiving BCS (p = 0.025) and those not undergoing adjuvant RT (p = 0.041) showed higher LR rates. For malignant subtypes, local control (LC) rates at 5 years for BCS alone, BCS with adjuvant RT, TM alone, and TM with adjuvant RT were 80.7, 93.3, 92.4, and 100%, respectively (p = 0.033). Multivariate analyses revealed BCS alone, tumor size ≥ 5 cm, and positive margins as independent risk factors for LR. Margin-positive BCS alone showed poorest LC regardless of tumor size (62.5%, p = 0.007). For margin-negative BCS alone, 5-year LC rates for tumors ≥ 5 cm versus those < 5 cm were 71.8% versus 89.5% (p = 0.012). For borderline subtypes, only positive margins (p = 0.044) independently increased the risk of LR. DM developed exclusively in malignant subtypes and a prior LR event increased the risk of DM by sixfold (HR 6.2, 95% CI 1.6-16.1, p = 0.001). CONCLUSIONS: Malignant and borderline phyllodestumors with positive margins after surgery have high LR rates. After treatment by margin-negative BCS alone, patients with large malignant phyllodestumors ≥ 5 cm also have heightened risk of LR. Thus, such patients should be considered for additional local therapy.
Authors: A Thind; B Patel; K Thind; J Isherwood; B Phillips; K Dhaliwal; D D Remoundos Journal: Ann R Coll Surg Engl Date: 2020-01-10 Impact factor: 1.891
Authors: Philip M Spanheimer; Melissa P Murray; Emily C Zabor; Michelle Stempel; Monica Morrow; Kimberly J Van Zee; Andrea V Barrio Journal: Ann Surg Oncol Date: 2019-02-19 Impact factor: 5.344