Phyllodes tumors of the breast: A review of 32 cases

Most general surgeons involved in breast cancer care have limited experienc e with phyllodes tumors. We analyzed a comprehensive database incorporating 8567 breast cancer cases treated surgically in the Tulsa, Oklahoma, region between 1969 and 1993, This yielded 32 cases of phyllodes tumors (0.37%) i n 31 patients. The median age was 57 years (range, 18-91). There were 9 low -grade (28%), 2 intermediate-grade (6%), and 21 high-grade (66%) lesions. S ize distribution consisted of 23 (72%) lesions 5 cm or less and 9 (28%) gre ater than 5 cm (mean, 3; range, 1.2-17.5 cm), Of 137 resected nodes in 13 p atients, none were positive for metastatic disease. Surgical management con sisted of wide excision or mastectomy. No patients received adjuvant chemor adiation therapy. The disease-free, locoregional disease-free, and overall mean survival rates were 80, 81, and 97 months, respectively. Ten-year dise ase-free survival (DFS), locoregional disease-free survival (LRDFS), and ov erall survival (OS) rates were 66, 72, and 55 per cent, respectively. Altho ugh there was a tendency toward a higher rate of locoregional recurrences a nd metastases with high-grade lesions, this was not statistically significa nt and did not affect DFS, LRDFS, or OS rates. Similarly, size of lesion di d not affect DFS, LRDFS, or OS rates. Three patients (9.6%) had metastatic disease at presentation, and a further two (6.4%) developed metastases duri ng follow-up. Overall, nine (28.1%) recurrences developed in eight patients , seven locoregional and two distant. Four patients (12.9%) died with evide nce of disease. These findings indicate prolonged survival in this patient population with cystosarcoma phyllodes, Wide local excision of primary and recurrent lesions remains the mainstay of therapy. Neither regional lymph n ode dissection nor adjuvant chemoradiation adds significant benefit.