Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998-2009.

Abstract

BACKGROUND:

Malignant phyllodes tumors of the breast have traditionally been treated with surgical excision. Recently, the use of adjuvant radiotherapy has been advocated to reduce the risk of local recurrence; however, this recommendation is controversial in the absence of consistent outcome data. We hypothesize that there has been a trend toward increased utilization of adjuvant radiotherapy for malignant phyllodes tumors despite its uncertain effect on outcomes.

METHODS:

Using the National Cancer Data Base, predictors of radiotherapy utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan-Meier and Cox regression models were generated to determine the effect of radiotherapy on local recurrence (LR), disease-free survival (DFS), and overall survival (OS).

RESULTS:

Of the 3,120 patients with malignant phyllodes, 57 % underwent breast conservation surgery and 42 % underwent mastectomy. Overall, 14.3 % of women received adjuvant radiotherapy. Utilization of radiotherapy doubled over the study period (9.5 % in 1998-1999 vs. 19.5 % in 2008-2009, p < 0.001). Women were significantly more likely to receive radiotherapy if they were diagnosed later in the study, were age 50-59 years old, had tumors >10 cm, or had lymph nodes removed. For the 1,774 patients with available recurrence data, overall recurrence was 14.1 %, and LR was 5.9 %. In adjusted models, adjuvant radiotherapy reduced LR (aHR 0.43, 95 % CI 0.19-0.95) but did not impact DFS or OS after 53 months' median follow-up.

CONCLUSIONS:

Utilization of adjuvant radiotherapy for malignant phyllodes doubled from 1998 to 2009. Radiotherapy significantly reduced LR but had no effect on DFS or OS.

• Authors: Jennifer L Gnerlich, Richelle T Williams, Katherine Yao, Nora Jaskowiak, Swati A Kulkarni
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 21 Issue 4 Pg. 1222-30 (Apr 2014) ISSN: 1534-4681 [Electronic] United States
• PMID: 24306659 (Publication Type: Journal Article)

Topics

• Adult
• Breast Neoplasms (mortality, radiotherapy, surgery)
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Humans
• Mastectomy
• Middle Aged
• Neoplasm Recurrence, Local (pathology, radiotherapy, surgery)
• Neoplasm Staging
• Phyllodes Tumor (mortality, radiotherapy, surgery)
• Prognosis
• Radiotherapy (statistics & numerical data)
• Retrospective Studies
• Survival Rate
• Time Factors