Breast Phyllodes Tumor—A Uni-institutional Analysis of the Epidemiology and Management Over the Past 20 Years

Abstract

suggests that in pathological complete responders (CR) and luminal A subtype locoregional radiation therapy may be avoided. Hence we audited LABC patients treated over a 6 year period to correlate the pathological response and intrinsic subtype to LRR. Materials/Methods: Consecutive patients of LABC who underwent NACT (taxane and or anthracyclines based) followed by definitive surgery and RT during the period January 2007 to December 2012 were the subject of this analysis. The pathological response to NACT in tumor as well as axillary nodes [complete response (pCR), partial response (pPR)] and the intrinsic subtype of tumor (Luminal A, Luminal B, Her-2 type, triple negative) was correlated with patterns of locoregional recurrence by chi square test and Cox-regression tests at a median follow-up of 48 months. Results: Among 206 patients, the median age of patients was 46 years (range 24-81 years), 46% were premenopausal, and 54% postmenopausal, 42% right sided and 58% left sided. The clinical prechemotherapy status of tumor and node at presentation was 15% T2, 40% T3, 45% T4 (9% T4a, 35% T4b, 1% T4c) 8% N0, 42% N1, 41% N2, 9% N3.The intrinsic subtype of our population at presentation was Luminal A (16%), Luminal B (23%), Her-2 Type (23%), triple negative (37%).The overall pCR rate to NACT in tumor and in node was 31% and 45%.The pCR rate in tumor according to intrinsic subtype was 26%, 23%, 39% and 31.5% in Luminal A, Luminal B,Her-2 Type and triple negative type respectively. The pCR rate in node was 26%, 38%, 41.6%, and 59% in Luminal A, Luminal B, Her-2 Type and triple negative type respectively. At a median follow-up of 48 months (interquartile range 24-64 mo) the overall LRR was 7.2% (3.3% chest wall, 1.9% ipsilateral axilla, 1.9% ipsilateral supraclavicular fossa). All chest wall recurrences were in Her-2 and triple negative and recurrences in ipsilateral axilla and supraclavicular fossa were in triple negative and luminal B subtypes (P Z ns). T4b had a higher propensity of chest wall recurrence. Pathological response did not affect LRR (P Z ns). LRR was an independent predictor for overall survival in spite of adjusting for distant metastases (HR 4, P Z 0.000). Conclusion: The overall LRR is 7.2% and is predominantly seen in Her-2 neu, triple negative and luminal B subtypes. The intrinsic subtype and pathological response did not affect LRR.