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Princess Margaret Hospital & Mount Sinai Hospital University of Toronto

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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
  • To report the outcomes of Malignant phyllodes tumors (MPT) and breast sarcomas (BS)
methods
Methods
  • 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
  • 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
  • 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
  • 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
  • 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.
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5 years OS : 71% (95%CI: 61-80)

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

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P <0.0001

1 = MPT

2= Angiosarc

3= Others

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No local failure following adjuvant RT.
  • Four (3%) has local recurrence without adjuvant RT (3 angiosarcomas and 1 MPT)
conclusions
Conclusions
  • 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
  • Princess Margaret Hospital Cancer registry
  • UHN Sarcoma group.
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