ABSTRACT
PURPOSE: The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART). METHODS: The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point. RESULTS: The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy-27.1%, and BCS- 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED. CONCLUSION: The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2-0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.
Subject(s)
Breast Neoplasms/therapy , Margins of Excision , Mastectomy, Segmental/methods , Neoplasm Recurrence, Local/epidemiology , Phyllodes Tumor/therapy , Radiotherapy, Adjuvant/methods , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Cancer Care Facilities , Female , Humans , Mastectomy/methods , Middle Aged , Phyllodes Tumor/pathology , Prognosis , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Here, the treatment methods and results of patients with phyllodes tumor of the breast (PT) with distant metastases at a single institution are presented. METHODS: A retrospective analysis was performed on a group of 295 patients with PT treated from 1952 to 2010. RESULTS: Distant metastases developed in 37 (12.5 %) patients; 3/160 (1.9 %) patients had benign PT, 6/36 (16.7 %) were considered borderline, and 28/99 (28.3 %) had malignant PT. Most frequently, the metastases were located in the lungs; 28 (75.7 %), bone 7 (18.9 %), brain 4 (10.8 %), and liver 2 (5.4 %). Metastases occurred on overage 21 months (2-57) after surgery. Patients with lung metastases were generally treated with monochemotherapy or polychemotherapy. In one patient Testosterone and in two patients resection of metastases combined with Doxorubicin were used. Patients with bones or brain metastases were treated with palliative radiotherapy only or combined with Doxorubicin. The mean survival (MS) from diagnosis of distant metastases (DM) was 7 months (2-17). The longest mean survival in patients with bones metastases was 11.8 months, the worst survival was for patients with brain metastases--2.8 months. Hormone therapy appeared to have low efficacy (MS: 2 months) as well as monochemotherapy (MS: 3-5 months). Improved MS was obtained using Doxorubicin (7 months) and Doxorubicin with Cisplatin, Cyclophosphamide, or Ifosfamide (9 months). CONCLUSION: The prognosis of patients with DM from PT is poor. The role of surgery and irradiation of such patients is very limited. There appears to be no role for the use of hormone therapy. This study showed that polychemotherapy with Doxorubicin and Ifosfamide suggest that it might be more effective than once thought.
Subject(s)
Breast Neoplasms/pathology , Phyllodes Tumor/secondary , Phyllodes Tumor/therapy , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Brain Neoplasms/secondary , Brain Neoplasms/therapy , Combined Modality Therapy , Doxorubicin/administration & dosage , Female , Humans , Ifosfamide/administration & dosage , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Middle Aged , Prognosis , Retrospective StudiesABSTRACT
Seventeen children with acute monocytic leukemia were treated with (a) vinblatine (with or without prednisone), 0.2 mg/kg of body weight twice a week (13 patients); (b) 6-mercaptopurine plus prednisone patient). Four patients died within the 1st week, before having an adequate chemotherapeutic trial, and a fifth patient died of spesis at 12 days. Five patients achieved complete remissions and two achieved in this study was 41%. For the 13 patients who survived more than 1 week, the remission rate was 53.8%. Remission occurred with vinblastine inall but one patient. Of the ten patients who recieved more than one dose of vinblastine, 60% achieved a remission, indicating that vinblastine is an active agent in this rare form of leukemia.
