ctos 2009 15 years experience of management of malignant phyllodes tumor and breast sarcoma at...
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CTOS 2009
15 years Experience of Management of Malignant Phyllodes Tumor and Breast Sarcoma at
Princess Margaret Hospital
Princess Margaret Hospital & Mount Sinai HospitalUniversity of Toronto
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
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 : 1 (1%)
CTOS 2009
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)
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
0 5 10 15 20
0.0
0.2
0.4
0.6
0.8
1.0
Time (years)
Su
rviv
al
Overall SurvivalProgression Free Survival
5 years OS : 71% (95%CI: 61-80)
5 years PFS : 64% (95%CI: 54-74)
CTOS 2009
0 5 10 15 20
0.0
0.2
0.4
0.6
0.8
1.0
Time (years)
Su
rviv
al
Histology group 1Histology group 2Histology group 3
P <0.0001
1 = MPT
2= Angiosarc
3= Others
CTOS 2009
•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 PFS
HR(95%CI) Uni Multi HR(95%CI) Uni Multi
Histology
(2 vs 1)
4.7 (2.2 -10.3) <0.0001 0.0004 4.6 (2.3 -9.4) <0.0001 0.0001
(3 vs 1) 2.7 (0.96 -7.7) 2.5 (1.0 -6.4)
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
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 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