The Impact of Radiotherapy and Histological Risk Factors on Outcomes in Malignant Phyllodes Tumors

Wong, Ru Xin; Koh, Yen Sin; Wong, Fuh Yong; Kusumawidjaja, Grace; Ng, W.L.; Yeo, Reuben J.; Farid, Mohamad; Chan, Jason Yongsheng; Yan, Zhiyan; Gudi, Mihir; Tan, Puay Hoon

doi:10.1016/j.clbc.2020.05.004

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Wong et al investigated the impact of adjuvant radiotherapy on outcomes in patients diagnosed with malignant PTs. The authors observed a beneficial effect of radiotherapy in terms of decreased risk of locoregional failure and improved locoregional recurrence-free survival ( 28 ). Boutrus et al conducted a single institutional retrospective review of patients diagnosed with phyllodes breast tumors demonstrating a significant benefit of adjuvant radiotherapy on local control in the borderline/malignant group, both in univariate and multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

Real-world efficacy of postoperative radiotherapy with a moderate dose-escalation for phyllodes tumors of the breast

Álvarez,

Montero,

Ciérvide

et al. 2023

Transl Breast Cancer Res

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Background Phyllodes tumors are rare breast tumors comprising less than 1% of cases, categorized as benign, borderline, or malignant. Treatment typically involves complete surgical excision with wide margins. Adjuvant radiotherapy may be recommended for borderline or malignant tumors, or when clear margins cannot be achieved through surgery alone. Methods We conducted a retrospective review of 14 women diagnosed with phyllodes tumors between 2015 and 2023. Among them, 36% had benign tumors and 64% had borderline/malignant tumors. The majority (86%) underwent breast-conserving surgery. Postoperative radiation therapy was delivered to the whole breast/chest wall, with a median biologically effective dose (BED) of 92.7 Gy (90.0–102.6 Gy), representing a moderate dose-escalation over conventional breast cancer schedules Results After a median follow-up of 48.5 months, no local or distant recurrence were observed. Mild to moderate skin toxicity occurred in all patients: 36% reported grade 1, 43% grade 2, and 21% grade 3 toxicity. One patient developed grade 2 fibrosis during follow-up. No significant correlations were found between the severity of acute/late toxicity and tumor size, surgical approach, or the radiation field’s planning target volume (PTV). Conclusions Adjuvant radiation therapy appears to be well tolerated and feasible for high-risk phyllodes tumors. However, the decision to utilize radiotherapy should be personalized, considering tumor characteristics and the risks and benefits associated with treatment.

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Section: Discussionmentioning

confidence: 99%

Real-world efficacy of postoperative radiotherapy with a moderate dose-escalation for phyllodes tumors of the breast

Álvarez,

Montero,

Ciérvide

et al. 2023

Transl Breast Cancer Res

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“…However, postoperative pathology proved that all the lymph nodes were negative. Studies have shown that adjuvant radiotherapy can lower the rate of local reoccurrence, particularly for patients with positive margins for borderline and malignant tumors [19][20][21]. Margin-negative resection combined with adjuvant radiotherapy is very effective for local control and prevention of recurrence [6].…”

Section: Discussionmentioning

confidence: 99%

Kiss Flaps to Repair Large Skin Defect After Excision of Giant Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

Luo¹,

Zou²,

Hu³

et al. 2021

Preprint

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Background: Malignant phyllodes tumors of the breast are fairly rare and fast-growing tumors. They do not respond to chemotherapy or hormonal therapy except in malignant phyllodes tumors. Therefore, the primary treatment for malignant phyllodes tumors is wide surgical excision. Case presentation: Herein, we report a case study which featured a 26-year-old woman presented with a giant malignant phyllodes tumor measuring 20 × 17 × 13 cm. In order to reduce the chance of local recurrence, treatment for these types of tumors usually involves extensive excision with at least 1 cm of surgical margins. The patient underwent extended lumpectomy with 1-3 cm surgical margins, which left a large skin defect of 25 × 15 cm. Repair of such a large skin defect is a challenge to breast surgeons. This is the first reported case in which a “kiss” flap was successfully used to repair the skin defect created after resection of a giant malignant phyllodes tumor.Conclusions: The kiss flap could be considered as an effective method to repair large chest wall defects after resection of giant phyllodes tumors.

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“…For localized malignant PT, the primary modality of treatment is surgical wide excision with or without adjuvant radiation therapy. Despite adequate local treatment, however, distant metastasis has been reported to occur in approximately a quarter of malignant PTs 6 , 7 . Upon systemic dissemination, no established standard therapy currently exists, and malignant PTs are known to be generally unresponsive to conventional chemotherapy or radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic and immunomodulatory potential of pazopanib in malignant phyllodes tumor

Lee

et al. 2022

npj Breast Cancer

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Malignant phyllodes tumors (PT) are rare aggressive fibroepithelial neoplasms with high metastatic potential and lack effective therapy. We established a patient-derived xenograft (PDX) and cell line model (designated MPT-S1) of malignant PT which demonstrated clinical response to pazopanib. Whole exome sequencing identified somatic mutations in TP53, RB1, MED12, and KMT2D. Immunohistochemistry and genomic profiles of the tumor, PDX and cell line were concordant. In keeping with clinical observation, pazopanib reduced cell viability in a dose-dependent manner and evoked apoptosis, and led to significant abrogation of in vivo tumor growth. Whole transcriptomic analysis revealed that pazopanib decreased expression of genes involved in oncogenic and apoptosis signaling. We also observed decreased expression of ENPP1, with known roles in cancer invasion and metastasis, as well as STING pathway upregulation. Accordingly, pazopanib induced micronuclei formation, and evoked phospho-TBK1 and PD-L1 expression. In an additional cohort of malignant PT (n = 14), six (42.9%) showed comparable or higher levels of ENPP1 relative to MPT-S1, highlighting its potential role as a therapeutic target. In conclusion, we established MPT-S1, a new PDX and cell line model, and provided evidence for the clinical efficacy of pazopanib in malignant PT.

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The Impact of Radiotherapy and Histological Risk Factors on Outcomes in Malignant Phyllodes Tumors

Cited by 6 publications

References 15 publications

Real-world efficacy of postoperative radiotherapy with a moderate dose-escalation for phyllodes tumors of the breast

Real-world efficacy of postoperative radiotherapy with a moderate dose-escalation for phyllodes tumors of the breast

Kiss Flaps to Repair Large Skin Defect After Excision of Giant Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

Therapeutic and immunomodulatory potential of pazopanib in malignant phyllodes tumor

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