MALIGNANT CYSTOSARCOMA-PHYLLODES

This study reviewed 26 women who had resection of a malignant cystosar coma phyllodes. Clinical presentations were palpable mass, 25; pain, 1 1; and ulceration, 2. Definitive surgical therapy was radical mastecto my (RM), 2; modified radical mastectomy (MRM), 14; total mastectomy (T M), 4; and partial mastectomy (PM), 6. Tumors ranged in size from 1-20 cm (median, 7 cm). Eight patients developed recurrent disease after 1 0-45 months. Local recurrence was more likely after TM and PM than aft er MRM and RM (P < 0.05). Patients who developed local recurrence only were treated by wide re-excision, and all such patients are alive wit h no evidence of disease at 5-25 years. Only one of 16 patients underg oing axillary dissection had involved lymph nodes. Four patients whose tumors ranged from 5-8 cm and who underwent one RM and three MRM deve loped systemic recurrence; all died of their disease after 15-48 month s. Conclusion: 1) Although there is a higher local recurrence after PM and TM as compared with MRM and RM for malignant cystosarcoma phyllod es, the local recurrence can be treated with wide excision without aff ecting long-term survival; 2) systemic recurrence was not related to s ize or extent of resection; 3) axillary dissection does not predict fo r or prevent recurrence.