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

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

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  1. 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

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

  3. 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%)

  4. 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%)

  5. 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)

  6. 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)

  7. 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.

  8. 5 years OS : 71% (95%CI: 61-80) 5 years PFS : 64% (95%CI: 54-74)

  9. P <0.0001 1 = MPT 2= Angiosarc 3= Others

  10. No local failure following adjuvant RT. • Four (3%) has local recurrence without adjuvant RT (3 angiosarcomas and 1 MPT)

  11. Univariate and Multivariate Analysis

  12. 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.

  13. Acknowledgement • Princess Margaret Hospital Cancer registry • UHN Sarcoma group.

  14. 1991-2007 PMH Breast Cancer Report

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