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. 2023 Jun;199(2):293-304.
doi: 10.1007/s10549-023-06896-1. Epub 2023 Mar 6.

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

Carl Sars  1 , Helena Sackey  2   3 , Jan Frisell  2   3 , Paul W Dickman  4 , Fredrik Karlsson  2   3 , Isabelle Kindts  5 , Gustavo Nader Marta  6 , Ruffo Freitas-Junior  7 , Tove Filtenborg Tvedskov  8 , Loay Kassem  9 , Ahmed S Ali  9 , Hanna Ihalainen  10 , Mathias Neron  11 , Michalis Kontos  12 , Orit Kaidar-Person  13   14 , Icro Meattini  15   16 , Anne Brecht Francken  17 , Frederieke van Duijnhoven  18 , Ingvild Ona Moberg  19 , Tanja Marinko  20   21 , Attila Kollar  22 , Mahbubl Ahmed  23 , Dennis Remoundos  24 , Jenny Banks  25 , Reshma Jagsi  26 , Lesly A Dossett  27 , Ebba K Lindqvist  28   29
Affiliations

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

Carl Sars et al. Breast Cancer Res Treat. 2023 Jun.

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.

Keywords: Breast neoplasms; Margins of excision; Phyllodes tumor; Surgical oncology.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. Outside the submitted work, RJ has stock options as compensation for her advisory board role in Equity Quotient, a company that evaluates culture in health care companies; she has received personal fees from the Greenwall Foundation, Doris Duke Charitable Foundation, and the National Institutes of Health and grants or contracts for unrelated work from the National Institutes of Health, the Doris Duke Charitable Foundation, the American Cancer Society, the Greenwall Foundation, Genentech, and Blue Cross Blue Shield of Michigan. She has served as an expert witness for Sherinian and Hasso, Dressman Benzinger LaVelle, and Kleinbard, LLC.

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