Management of the Phyllodes Tumor of the Breast (PTB)
Lisa Jacobs, MD
Little is known about the appropriate local management for Phyllodes Tumors of the Breast (PTB). The current National Comprehensive Cancer Network (NCCN) guideline stated that subtype of PTB (benign, borderline and malignant) appears less important for risk of recurrence than does the margin of tumor-free resection achieved by surgical treatment. The guideline recommends BCS as a preferred treatment when possible and the efficacy of radiotherapy (RT) is still controversial. The recommendation was based on a small, retrospective, single-center experience (Chaney AW et al, Cancer, 2000,89:1502-1511). Therefore, we performed a literature review and pooled analysis, which revealed that benign PTB has a significantly lower local recurrence rate, when compared with borderline/malignant PTB (Poster presentation at 2014 American Society of Breast Surgeon annual meeting). Hence, we are questioning whether different surgical management is needed in PTB with different subtypes. We are also interested in looking for risk factors for local failure after local therapy of PTB. As PTB constitutes only 1% of breast neoplasm, a prospective randomized trial is impractical and time-consuming. Kai Chen and I proposed a multicenter, retrospective study to address this question in Translational Breast Cancer Research Consortium (TBCRC) Meeting. We are preparing the protocol which will be submitted to the steering committee for final approval.
I am going to conduct a parallel study, together with Kai Chen and his instructor, Fengxi Su, in China, to investigate whether the surgical treatment patterns and the local control rate of PTB is similar in Chinese populations, when compared with the multicenter cohort of our TBCRC study. Fengxi Su, is going to assist me to collect PTB samples from not only SYSU, but also from other hospitals in Guangzhou, China. We are going to use Redcap for data management. Our Chinese collaborators (Kai Chen and Fengxi Su) will be responsible for collection of samples and follow-up information of patients. Samples (Slices) will be sent to pathology at JHU who will review the slices and confirm the pathology diagnosis. Kai Chen, Fengxi Su and I are going to analyze the clinical data together.