Definitive Management of Malignant Phyllodes of the Breast

Abstract

Background

Malignant phyllodes tumors (MPT) are rare, aggressive fibroepithelial breast neoplasms with limited consensus on optimal management. While wide local excision (WLE) with ≥1 cm margins is standard, recurrence remains common, and the role of adjuvant therapy remains unclear.

Methods

We conducted a 28-year retrospective review of 14 histologically confirmed MPTs in 11 patients at a single urban safety-net hospital. Clinical, pathologic, and treatment data were analyzed to assess recurrence, metastasis, and treatment outcomes.

Results

The median tumor size was 7.6 cm. Most patients (73%) presented with stage II disease. Surgical management included WLE alone (45.5%), WLE with radiation (27.3%), mastectomy alone (9.1%), and mastectomy with adjuvant radiation (18.2%). Local recurrence occurred in 3 patients (27.3%), all of whom were initially treated with surgery alone. Those who recurred received adjuvant radiation; no recurrences occurred after adjuvant radiation. One patient developed metastases and received systemic chemotherapy. Only 1 patient underwent genetic testing, which revealed a TP53 mutation.

Conclusions

Recurrence occurred often despite margin-negative resections, highlighting the limitations of current surgical guidelines and the potential importance of tumor biology. These findings support a more individualized treatment approach that incorporates histologic features and, when appropriate, genetic testing. Adjuvant radiation may reduce the risk of recurrence in high-risk cases, although our small cohort precludes definitive conclusions. These findings should be considered hypothesis-generating and highlight the need for prospective or registry-based studies.