Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta‑analysis

Zeng,Shiyan; Zhang,Xindan; Yang,Dejuan; Wang,Xiaoyi; Ren,Guosheng

doi:10.3892/mco.2015.503

Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta‑analysis

Authors:
- Shiyan Zeng
- Xindan Zhang
- Dejuan Yang
- Xiaoyi Wang
- Guosheng Ren
View Affiliations

Affiliations: Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China, Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
Published online on: February 6, 2015 https://doi.org/10.3892/mco.2015.503
Pages: 663-671

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The standard treatment for borderline and malignant phyllodes tumors is wide local excision (margins ≥1 cm), in the context of either breast‑conserving surgery (BCS) or total mastectomy (TM). Due to the high risk of local recurrence (LR) following surgical intervention alone, the addition of adjuvant radiotherapy (RT) has been previously investigated; however, the conclusions have been inconsistent. This systematic review and meta‑analysis was designed to assess the efficacy of adjuvant RT for borderline and malignant phyllodes tumors. Pubmed and Web of Science were systematically searched to identify relevant studies assessing the effect of adjuvant RT on borderline and malignant phyllodes tumors from the inception of this technique through May, 2014. A total of 8 studies were identified among 332 citations. In this meta‑analysis, patients who received adjuvant RT had a lower relative risk of LR [hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.23‑0.64]. The absolute risk difference was 10.1% (95% CI: 4.9‑17.6), corresponding to a number needed to treat of 10. Our pooled meta‑analysis clearly demonstrated a decreased risk of LR in patients with borderline and malignant phyllodes tumors who received RT following BCS (HR=0.31, 95% CI: -0.10‑0.72). However, the combined HR for LR in the TM group did not demonstrate that adjuvant RT was superior to no RT (HR=0.68, 95% CI: -0.28‑1.64). No significant differences were observed in overall survival (OS) or disease‑free survival (DFS) between the two groups. Our analysis suggested that adjuvant RT for borderline and malignant phyllodes tumors decreased the LR rate in patients undergoing BCS. However, adjuvant RT was not found to exert an effect on OS or DFS.

View Figures

View References

1	Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW and Ellis IO: Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases. Histopathology. 27:205–218. 1995. View Article : Google Scholar : PubMed/NCBI
2	Bernstein L, Deapen D and Ross RK: The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 71:3020–3024. 1993. View Article : Google Scholar : PubMed/NCBI
3	Bartoli C, Zurrida SM and Clemente C: Phyllodes tumor in a male patient with bilateral gynaecomastia induced by oestrogen therapy for prostatic carcinoma. Eur J Surg Oncol. 17:215–217. 1991.PubMed/NCBI
4	Keelan PA, Myers JL, Wold LE, Katzmann JA and Gibney DJ: Phyllodes tumor: clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients. Hum Pathol. 23:1048–1054. 1992. View Article : Google Scholar : PubMed/NCBI
5	Tan PH, Jayabaskar T, Chuah KL, et al: Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 123:529–540. 2005. View Article : Google Scholar : PubMed/NCBI
6	Rowell MD, Perry RR, Hsiu JG and Barranco SC: Phyllodes tumors. Am J Surg. 165:376–379. 1993. View Article : Google Scholar : PubMed/NCBI
7	Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J and Smolak K: The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 77:910–916. 1996. View Article : Google Scholar : PubMed/NCBI
8	Barth RJ Jr: Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 57:291–295. 1999. View Article : Google Scholar : PubMed/NCBI
9	Tan PH, Thike AA, Tan WJ, et al: Phyllodes Tumour Network Singapore: Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 65:69–76. 2012. View Article : Google Scholar : PubMed/NCBI
10	Abdalla HM and Sakr MA: Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J Egypt Natl Canc Inst. 18:125–133. 2006.PubMed/NCBI
11	Chaney AW, Pollack A, McNeese MD, et al: Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 89:1502–1511. 2000. View Article : Google Scholar : PubMed/NCBI
12	Asoglu O, Ugurlu MM, Blanchard K, et al: Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol. 11:1011–1017. 2004. View Article : Google Scholar : PubMed/NCBI
13	Macdonald OK, Lee CM, Tward JD, Chappel CD and Gaffney DK: Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 107:2127–2133. 2006. View Article : Google Scholar : PubMed/NCBI
14	Belkacémi Y, Bousquet G, Marsiglia H, et al: Phyllodes tumor of the breast. Int J Radiat Oncol Biol Phys. 70:492–500. 2008. View Article : Google Scholar : PubMed/NCBI
15	Chen WH, Cheng SP, Tzen CY, et al: Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 91:185–194. 2005. View Article : Google Scholar : PubMed/NCBI
16	Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ and Souba WW: Surgical management of phyllodes tumors. Arch Surg. 134:487–492. 1999. View Article : Google Scholar : PubMed/NCBI
17	Kapiris I, Nasiri N, A'Hern R, Healy V and Gui GP: Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol. 27:723–730. 2001. View Article : Google Scholar : PubMed/NCBI
18	Barrio AV, Clark BD, Goldberg JI, et al: Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 14:2961–2970. 2007. View Article : Google Scholar : PubMed/NCBI
19	Guillot E, Couturaud B, Reyal F, et al: Management of phyllodes breast tumors. Breast J. 17:129–137. 2011. View Article : Google Scholar : PubMed/NCBI
20	Barth RJ Jr, Wells WA, Mitchell SE and Cole BF: A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 16:2288–2294. 2009. View Article : Google Scholar : PubMed/NCBI
21	Ellis I, Sawyer EJ, Rampaul R and Pineda CG: Phyllodes tumor of the breastTextbook of Uncommon Cancer. Raghavan D, Brecher ML, Johnson DH, MerOpol NJ, Moots PL and Rose PG: 3rd. Wiley; Chichester: pp. 209–217. 2006, View Article : Google Scholar
22	Pezner RD, Schultheiss TE and Paz IB: Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 71:710–713. 2008. View Article : Google Scholar : PubMed/NCBI
23	Parker SJ and Harries SA: Phyllodes tumours. Postgrad Med J. 77:428–435. 2001. View Article : Google Scholar : PubMed/NCBI
24	Barth R J Jr: Margin negative, breast conserving resection: adequate for benign phyllodes tumors, but inadequate therapy for borderline and malignant phyllodes tumors. Breast Cancer Res Treat. 142:463–464. 2013. View Article : Google Scholar : PubMed/NCBI
25	Gnerlich JL, Williams RT, Yao K, Jaskowiak N and Kulkarni SA: Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998–2009. Ann Surg Oncol. 21:1222–1230. 2014. View Article : Google Scholar : PubMed/NCBI
26	Carlson RW, Allred DC, Anderson BO, et al: Metastatic breast cancer, version 1.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 10:821–829. 2012.PubMed/NCBI
27	Higgins JP and Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med. 21:1539–1558. 2002. View Article : Google Scholar : PubMed/NCBI
28	Atkins D, Best D, Briss PA, et al: Grade Working Group: Grading quality of evidence and strength of recommendations. BMJ. 328:14902004. View Article : Google Scholar : PubMed/NCBI
29	Jaeschke R, Guyatt GH, Dellinger P, et al: Use of grade grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 337:a7442008.(In French). View Article : Google Scholar : PubMed/NCBI
30	Haberer S, Laé M, Seegers V, et al: Management of malignant phyllodes tumors of the breast: the experience of the Institut Curie. Cancer Radiother. 13:305–312. 2009. View Article : Google Scholar : PubMed/NCBI
31	Soumarová R, Seneklová Z, Horová H, et al: Retrospective analysis of 25 women with malignant cystosarcoma phyllodes - treatment results. Arch Gynecol Obstet. 269:278–281. 2004. View Article : Google Scholar : PubMed/NCBI
32	Pandey M, Mathew A, Kattoor J, et al: Malignant phyllodes tumor. Breast J. 7:411–416. 2001. View Article : Google Scholar : PubMed/NCBI
33	Kim S, Kim JY, do H Kim, Jung WH and Koo JS: Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 141:353–363. 2013. View Article : Google Scholar : PubMed/NCBI
34	Badar F, Mahmood S, Syed AA and Siddiqui N: Malignant phyllodes tumour of the breast. J Ayub Med Coll Abbottabad. 24:47–49. 2012.PubMed/NCBI
35	Reinfuss M, Mituś J, Smolak K and Stelmach A: Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases. Eur J Cancer. 29A:1252–1256. 1993. View Article : Google Scholar : PubMed/NCBI
36	Chaney AW, Pollack A, McNeese MD and Zagars GK: Adjuvant radiotherapy for phyllodes tumor of breast. Radiat Oncol Investig. 6:264–267. 1998. View Article : Google Scholar : PubMed/NCBI