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Princess Margaret Hospital & Mount Sinai Hospital University of Toronto

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

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Princess Margaret Hospital & Mount Sinai Hospital University of Toronto

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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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