15 years Experience of Management of Malignant Phyllodes Tumor and Breast Sarcoma at
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15 years Experience of Management of Malignant Phyllodes Tumor and Breast Sarcoma at Princess Margaret Hospital.

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15 years Experience of Management of Malignant Phyllodes Tumor and Breast Sarcoma at Princess Margaret Hospital

Nikhilesh Patil, Charles Catton, Brian O’Sullivan, Robert Dinniwell, Anthony Griffin, Peter C Ferguson, Rebecca Gladdy, David McCready, Martin Blackstein, Abha Gupta, Lisa W Le, Peter Chung

Princess Margaret Hospital

& Mount Sinai Hospital

University of Toronto


Purpose
Purpose Tumor and Breast Sarcoma at

  • To report the outcomes of Malignant phyllodes tumors (MPT) and breast sarcomas (BS)


Methods
Methods Tumor and Breast Sarcoma at

  • Retrospective review (Jan 1991 to Dec 2006)

  • N = 111

  • 3 Groups 1) MPT :75 (68%)

    2) Angiosarcomas :22 (18%)

    3) Others :14 (14%)

  • Grade:

    Low : 29 (26%)

    Intermediate : 10 (9%)

    High : 48 (43%)

    NOS : 24 (22%)


Histologic subtypes
Histologic subtypes Tumor and Breast Sarcoma at

  • Malignant phyllodes : 75 (68%)

  • Angiosarcomas : 22 (18%)

  • Sarcoma NOS : 7 (7%)

  • Fibrosarcoma : 3 (3%)

  • Leiomyosarcoma : 1 (1%)

  • Liposarcoma : 1 (1%)

  • Mxyoid NOS : 1 (1%)

  • Alvelolar RMS : 1 (1%)


Surgical details
Surgical details Tumor and Breast Sarcoma at

  • Mastectomy alone : 47 (42%)

  • Mastectomy +RT : 34 (31%)

  • Wide local excision/Lumpectomy alone : 11 (10%)

  • Wide local excision +RT : 17 (15%)

  • Margin:

    • Negative : 84 (76%)

    • Close (<1cms) : 12 (11%)

    • Positive : 13 (12%)

  • 2 patients were not offered sx (1 alveolar RMS because of no residual disease after chemotherapy and other large tumor with bleeding – palliative RT)


  • Rt details
    RT details Tumor and Breast Sarcoma at

    • Rationale for RT : Close/+ margins in lumpectomy/mastectomy (usually deep margin in absence of removal of pectoral fascia). We consider wide margin to be >1-2cm.

    • N : 53 (48%)

    • Indication

      • Adjuvant RT : 41(lumpectomy = 16, mastectomy = 25),

      • Recurrent disease : 3

      • Palliative : 6

      • Pre-op RT : 3

  • Technique

    • Tangents : 41

    • IMRT : 5

    • Others : 6

  • Median dose : 50 GY (range 20-63)


  • Results
    Results Tumor and Breast Sarcoma at

    • Median age : 47 yrs (range 17- 83)

    • Median tumor size : 5cms (range 0.5 – 27)

    • Median follow up : 5.2 yrs (range 0.1 – 18.8 yrs)

    • Controlled (local+distant) : 71( 64%)

    • Local relapse : 4 ( 4%)

    • Distant relapse : 36 (32%)

    • 10 patients had prior radiation (angiosarcomas) following surgery for breast cancer. Therefore did not have further rads.


    5 years OS : 71% (95%CI: 61-80) Tumor and Breast Sarcoma at

    5 years PFS : 64% (95%CI: 54-74)


    P <0.0001 Tumor and Breast Sarcoma at

    1 = MPT

    2= Angiosarc

    3= Others



    Univariate and multivariate analysis
    Univariate and Multivariate Analysis Tumor and Breast Sarcoma at


    Conclusions
    Conclusions Tumor and Breast Sarcoma at

    • Mastectomy for malignant phyllodes tumor and sarcomas of the breast achieves excellent local control.

    • Wide local excision with breast conservation is feasible (+/- RT) with excellent local control in select patients

    • Adjuvant radiotherapy should be considered when wide margins are not possible.

    • Management of breast sarcoma should follow the same local control principles as for other sarcomas of the superficial tissues.

    • Poor outcome of angiosarcomas warrants further research.


    Acknowledgement
    Acknowledgement Tumor and Breast Sarcoma at

    • Princess Margaret Hospital Cancer registry

    • UHN Sarcoma group.


    1991 2007 pmh breast cancer report
    1991-2007 PMH Breast Cancer Report Tumor and Breast Sarcoma at


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