Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists

Carl Sars*, Helena Sackey, Jan Frisell, Paul W. Dickman, Fredrik Karlsson, Isabelle Kindts, Gustavo Nader Marta, Ruffo Freitas-Junior, Tove Filtenborg Tvedskov, Loay Kassem, Ahmed S. Ali, Hanna Ihalainen, Mathias Neron, Michalis Kontos, Orit Kaidar-Person, Icro Meattini, Anne Brecht Francken, Frederieke van Duijnhoven, Ingvild Ona Moberg, Tanja MarinkoAttila Kollar, Mahbubl Ahmed, Dennis Remoundos, Jenny Banks, Reshma Jagsi, Lesly A. Dossett, Ebba K. Lindqvist

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. Methods: We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. Results: A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. Conclusions: This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.

Original languageEnglish
Pages (from-to)293-304
Number of pages12
JournalBreast Cancer Research and Treatment
Volume199
Issue number2
DOIs
StatePublished - Jun 2023

Funding

FundersFunder number
Blue Cross Blue Shield of Michigan
National Institutes of Health
American Cancer Society
Doris Duke Charitable Foundation
Greenwall Foundation
Genentech
Karolinska Institutet

    Keywords

    • Breast neoplasms
    • Margins of excision
    • Phyllodes tumor
    • Surgical oncology

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