15 years Experience of Management of Malignant

Phyllodes Tumor and Breast Sarcoma at

Princess Margaret Hospital

Nikhilesh Patil, Charles Catton, Brian

OSullivan, 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

CTOS 2009

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

CTOS 2009

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%)

CTOS 2009

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
CTOS 2009

: 1 (1%)

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)
Positive

: 12 (11%)

: 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)

CTOS 2009

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)
CTOS 2009

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.

CTOS 2009

1.0
0.0

0.2

0.4

Survival

0.6

0.8

Overall Survival
Progression Free Survival

10

15

Time (years)

5 years OS : 71% (95%CI: 61-80)

5 years PFS : 64% (95%CI: 54-74)
CTOS 2009

20

1.0
0.6

0.8

P <0.0001

Survival

1 = MPT

0.4

2=
Angiosarc

0.2

3= Others

0.0

Histology group 1
Histology group 2
Histology group 3

10
Time (years)

CTOS 2009

15

20

No local failure following adjuvant RT.

Four (3%) has local recurrence without
adjuvant RT (3 angiosarcomas and 1 MPT)

CTOS 2009

Univariate and Multivariate

Analysis
OAS
HR(95%CI)
Histology 4.7 (2.2 -10.3)
(2 vs 1)

PFS

Uni

Multi

HR(95%CI)

Uni

Multi

<0.0001

0.0004

4.6 (2.3 -9.4)

<0.0001

0.0001

(3 vs 1)

2.7 (0.96 -7.7)

Age

1.4 (1.1 1.7)

0.02

0.02

1.3 (1.1 -1.6)

0.01

0.01

Tumor
Size

1.7 (1.1 2.7)

0.04

0.03

1.3 (0.9 2.1)

0.23

0.13

CTOS 2009

2.5 (1.0 -6.4)

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.
CTOS 2009

Acknowledgement
Princess Margaret Hospital Cancer
registry
UHN Sarcoma group.

CTOS 2009

1991-2007 PMH Breast Cancer Report

CTOS 2009

Visit Year

The number of Patients

1991

1123

1992

1277

1993

1351

1994

1260

1995

1334

1996

1486

1997

1578

1998

1652

1999

1419

2000

1038

2001

1062

2002

968

2003

1263

2004

1423

2005

1167

2006

1335

2007

1375

Total

22111

CTOS 2009