Primary treatment of cystosarcoma phyllodes of the breast

Arthur W. Chaney, Alan Pollack, Marsha D. Mcneese, Gunar K. Zagars, Peter W T Pisters, Raphael E. Pollock, Kelly K. Hunt

Research output: Contribution to journalArticle

223 Citations (Scopus)

Abstract

BACKGROUND. Cystosarcoma phyllodes is a rare sarcoma of the breast. Although surgical removal is the mainstay of treatment, the extent of surgery required (excision vs. mastectomy) and the need for additional local therapy, such as radiotherapy, are unclear. The current study evaluated the rate of local and distant failure, as well as potential prognostic factors, to better define appropriate treatment strategies: METHODS. One hundred one patients treated primarily for cystosarcoma phyllodes of the breast were evaluated. These tumors were classified histologically into benign (58%), indeterminate (12%), and malignant (30%) based on well defined criteria. Stromal overgrowth (29%) was considered separately. Surgery was comprised of local excision with breast conservation (47%) or mastectomy (53%). Microscopic surgical margins were negative in 99% of cases. Six patients received adjuvant radiotherapy. RESULTS. Overall survival for the 101 patients was 88%, 79%, and 62% at 5, 10, and 15 years, respectively. For patients with nonmalignant (benign or indeterminate) and malignant cystosarcoma phyllodes, the overall survival was 91% and 82%, respectively, at 5 years, and 79% and 42%, respectively, at 10 years. Similar rates were observed based on the presence or absence of stromal overgrowth. Local recurrence occurred in 4 patients, with an actuarial 10-year rate of 8%. Eight patients developed distant metastases, with an actuarial 10-year rate of 13%. Multivariate analysis using Cox proportional hazards regression revealed stromal overgrowth to be the only independent predictor of distant failure. CONCLUSIONS. Local failure in this group of largely margin negative patients with cystosarcoma phyllodes of the breast was low, showing that breast-conserving surgery with appropriate margins is the preferred primary therapy. The current study data do not support the use of adjuvant radiotherapy for patients with adequately resected disease. Patients with stromal overgrowth, particularly when the tumor size was > 5 cm, were found to have a high rate of distant failure; such patients merit consideration of a trial that examines the efficacy of systemic therapy. (C) 2000 American Cancer Society.

Original languageEnglish
Pages (from-to)1502-1511
Number of pages10
JournalCancer
Volume89
Issue number7
DOIs
StatePublished - Oct 1 2000
Externally publishedYes

Fingerprint

Phyllodes Tumor
Breast
Therapeutics
Adjuvant Radiotherapy
Mastectomy
Survival
Segmental Mastectomy
Sarcoma
Neoplasms
Radiotherapy
Multivariate Analysis

Keywords

  • Breast sarcoma
  • Phyllodes tumor
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chaney, A. W., Pollack, A., Mcneese, M. D., Zagars, G. K., Pisters, P. W. T., Pollock, R. E., & Hunt, K. K. (2000). Primary treatment of cystosarcoma phyllodes of the breast. Cancer, 89(7), 1502-1511. https://doi.org/10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P

Primary treatment of cystosarcoma phyllodes of the breast. / Chaney, Arthur W.; Pollack, Alan; Mcneese, Marsha D.; Zagars, Gunar K.; Pisters, Peter W T; Pollock, Raphael E.; Hunt, Kelly K.

In: Cancer, Vol. 89, No. 7, 01.10.2000, p. 1502-1511.

Research output: Contribution to journalArticle

Chaney, AW, Pollack, A, Mcneese, MD, Zagars, GK, Pisters, PWT, Pollock, RE & Hunt, KK 2000, 'Primary treatment of cystosarcoma phyllodes of the breast', Cancer, vol. 89, no. 7, pp. 1502-1511. https://doi.org/10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P
Chaney, Arthur W. ; Pollack, Alan ; Mcneese, Marsha D. ; Zagars, Gunar K. ; Pisters, Peter W T ; Pollock, Raphael E. ; Hunt, Kelly K. / Primary treatment of cystosarcoma phyllodes of the breast. In: Cancer. 2000 ; Vol. 89, No. 7. pp. 1502-1511.
@article{502e65a3f3884dcebdbf9dd636cddde9,
title = "Primary treatment of cystosarcoma phyllodes of the breast",
abstract = "BACKGROUND. Cystosarcoma phyllodes is a rare sarcoma of the breast. Although surgical removal is the mainstay of treatment, the extent of surgery required (excision vs. mastectomy) and the need for additional local therapy, such as radiotherapy, are unclear. The current study evaluated the rate of local and distant failure, as well as potential prognostic factors, to better define appropriate treatment strategies: METHODS. One hundred one patients treated primarily for cystosarcoma phyllodes of the breast were evaluated. These tumors were classified histologically into benign (58{\%}), indeterminate (12{\%}), and malignant (30{\%}) based on well defined criteria. Stromal overgrowth (29{\%}) was considered separately. Surgery was comprised of local excision with breast conservation (47{\%}) or mastectomy (53{\%}). Microscopic surgical margins were negative in 99{\%} of cases. Six patients received adjuvant radiotherapy. RESULTS. Overall survival for the 101 patients was 88{\%}, 79{\%}, and 62{\%} at 5, 10, and 15 years, respectively. For patients with nonmalignant (benign or indeterminate) and malignant cystosarcoma phyllodes, the overall survival was 91{\%} and 82{\%}, respectively, at 5 years, and 79{\%} and 42{\%}, respectively, at 10 years. Similar rates were observed based on the presence or absence of stromal overgrowth. Local recurrence occurred in 4 patients, with an actuarial 10-year rate of 8{\%}. Eight patients developed distant metastases, with an actuarial 10-year rate of 13{\%}. Multivariate analysis using Cox proportional hazards regression revealed stromal overgrowth to be the only independent predictor of distant failure. CONCLUSIONS. Local failure in this group of largely margin negative patients with cystosarcoma phyllodes of the breast was low, showing that breast-conserving surgery with appropriate margins is the preferred primary therapy. The current study data do not support the use of adjuvant radiotherapy for patients with adequately resected disease. Patients with stromal overgrowth, particularly when the tumor size was > 5 cm, were found to have a high rate of distant failure; such patients merit consideration of a trial that examines the efficacy of systemic therapy. (C) 2000 American Cancer Society.",
keywords = "Breast sarcoma, Phyllodes tumor, Radiotherapy, Surgery",
author = "Chaney, {Arthur W.} and Alan Pollack and Mcneese, {Marsha D.} and Zagars, {Gunar K.} and Pisters, {Peter W T} and Pollock, {Raphael E.} and Hunt, {Kelly K.}",
year = "2000",
month = "10",
day = "1",
doi = "10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P",
language = "English",
volume = "89",
pages = "1502--1511",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "7",

}

TY - JOUR

T1 - Primary treatment of cystosarcoma phyllodes of the breast

AU - Chaney, Arthur W.

AU - Pollack, Alan

AU - Mcneese, Marsha D.

AU - Zagars, Gunar K.

AU - Pisters, Peter W T

AU - Pollock, Raphael E.

AU - Hunt, Kelly K.

PY - 2000/10/1

Y1 - 2000/10/1

N2 - BACKGROUND. Cystosarcoma phyllodes is a rare sarcoma of the breast. Although surgical removal is the mainstay of treatment, the extent of surgery required (excision vs. mastectomy) and the need for additional local therapy, such as radiotherapy, are unclear. The current study evaluated the rate of local and distant failure, as well as potential prognostic factors, to better define appropriate treatment strategies: METHODS. One hundred one patients treated primarily for cystosarcoma phyllodes of the breast were evaluated. These tumors were classified histologically into benign (58%), indeterminate (12%), and malignant (30%) based on well defined criteria. Stromal overgrowth (29%) was considered separately. Surgery was comprised of local excision with breast conservation (47%) or mastectomy (53%). Microscopic surgical margins were negative in 99% of cases. Six patients received adjuvant radiotherapy. RESULTS. Overall survival for the 101 patients was 88%, 79%, and 62% at 5, 10, and 15 years, respectively. For patients with nonmalignant (benign or indeterminate) and malignant cystosarcoma phyllodes, the overall survival was 91% and 82%, respectively, at 5 years, and 79% and 42%, respectively, at 10 years. Similar rates were observed based on the presence or absence of stromal overgrowth. Local recurrence occurred in 4 patients, with an actuarial 10-year rate of 8%. Eight patients developed distant metastases, with an actuarial 10-year rate of 13%. Multivariate analysis using Cox proportional hazards regression revealed stromal overgrowth to be the only independent predictor of distant failure. CONCLUSIONS. Local failure in this group of largely margin negative patients with cystosarcoma phyllodes of the breast was low, showing that breast-conserving surgery with appropriate margins is the preferred primary therapy. The current study data do not support the use of adjuvant radiotherapy for patients with adequately resected disease. Patients with stromal overgrowth, particularly when the tumor size was > 5 cm, were found to have a high rate of distant failure; such patients merit consideration of a trial that examines the efficacy of systemic therapy. (C) 2000 American Cancer Society.

AB - BACKGROUND. Cystosarcoma phyllodes is a rare sarcoma of the breast. Although surgical removal is the mainstay of treatment, the extent of surgery required (excision vs. mastectomy) and the need for additional local therapy, such as radiotherapy, are unclear. The current study evaluated the rate of local and distant failure, as well as potential prognostic factors, to better define appropriate treatment strategies: METHODS. One hundred one patients treated primarily for cystosarcoma phyllodes of the breast were evaluated. These tumors were classified histologically into benign (58%), indeterminate (12%), and malignant (30%) based on well defined criteria. Stromal overgrowth (29%) was considered separately. Surgery was comprised of local excision with breast conservation (47%) or mastectomy (53%). Microscopic surgical margins were negative in 99% of cases. Six patients received adjuvant radiotherapy. RESULTS. Overall survival for the 101 patients was 88%, 79%, and 62% at 5, 10, and 15 years, respectively. For patients with nonmalignant (benign or indeterminate) and malignant cystosarcoma phyllodes, the overall survival was 91% and 82%, respectively, at 5 years, and 79% and 42%, respectively, at 10 years. Similar rates were observed based on the presence or absence of stromal overgrowth. Local recurrence occurred in 4 patients, with an actuarial 10-year rate of 8%. Eight patients developed distant metastases, with an actuarial 10-year rate of 13%. Multivariate analysis using Cox proportional hazards regression revealed stromal overgrowth to be the only independent predictor of distant failure. CONCLUSIONS. Local failure in this group of largely margin negative patients with cystosarcoma phyllodes of the breast was low, showing that breast-conserving surgery with appropriate margins is the preferred primary therapy. The current study data do not support the use of adjuvant radiotherapy for patients with adequately resected disease. Patients with stromal overgrowth, particularly when the tumor size was > 5 cm, were found to have a high rate of distant failure; such patients merit consideration of a trial that examines the efficacy of systemic therapy. (C) 2000 American Cancer Society.

KW - Breast sarcoma

KW - Phyllodes tumor

KW - Radiotherapy

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=0034306885&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034306885&partnerID=8YFLogxK

U2 - 10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P

DO - 10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P

M3 - Article

C2 - 11013364

AN - SCOPUS:0034306885

VL - 89

SP - 1502

EP - 1511

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 7

ER -