Phyllodes tumors are a rare distinctive fibroepithelial
tumors of the breast and their management continues to be questioned. The aim of our study was to examine the treatment and outcome of 165 patients with
phyllodes tumors and to review the options for surgical management. This is a retrospective study of 165 patients who presented to the Institut Curie between January 1994 and November 2008 for benign, borderline or malignant
phyllodes tumors. The median follow-up was 12.65 months [range 0-149.8]. The median age at diagnosis was 44 years [range 17-79]. One hundred and sixty patients (97%) had breast-conserving treatment, of whom 3 patients (1.8%) had oncoplastic breast surgery. Younger women had a significantly higher chance of having a benign
phyllodes tumor (p = 0.0001) or a
tumor of small size (p < 0.0001). Histologic examination showed 114 benign (69%), 37 borderline (22%) and 14 malignant
tumors (9%). The median
tumor size was 30 mm [range 5-150]. The
tumor margins were considered incomplete (< 10 mm) in 46 out of 165 cases (28%) with 52%
revision surgery. Only the
tumor grade was a significant risk factor for incomplete
tumor margins (p = 0.005). Fifteen patients developed local recurrence (10%) and two,
metastases. In univariate analysis, the histologic grade (p = 0.008), and
tumor size (p = 0.02) were significative risk factors for local recurrence with an accentuated risk for "borderline"
tumors and
tumors of large size.).Similar results were obtained using multivariate analysis (p = 0.07). The mainstay of treatment for
phyllodes tumors remains excision with a safe
surgical margin, taking advantage
breast conserving surgery where amenable. For borderline or malignant
phyllodes tumors or in cases of local
tumor recurrence,
mastectomy, and immediate
breast reconstruction may become the preferred option. Genetic analysis will potentially supplement classical histologic examination in order to improve our management of these
tumors. The role of adjuvant treatments is unproven and must be considered on a case-by-case basis.