How are phyllodes tumors (cystosarcoma phyllodes) treated?

Updated: Oct 10, 2018
  • Author: Donald R Lannin, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Complete excision, with accurate histologic examination and continued follow-up care, is the best way to treat phyllodes tumors. A general surgery specialist should be consulted.

In most cases, wide local excision is indicated, with a rim of normal tissue included. [23, 24, 8]  No absolute rules regarding margin size have been established. [25]  However, a 2-cm margin for small (< 5 cm) tumors and a 5-cm margin for large (>5 cm) tumors have been advocated.

Guidelines on benign breast tumors from the French College of Obstetrics and Gynecology (CNGOF) recommended surgical resection with clear margins for grade 1 (benign) phyllodes tumors and resection with 10-mm margins for grade 2 (borderline) phyllodes tumors. [26]  

The lesion should not be "shelled out," as might be done with a fibroadenoma, or the recurrence rate will be unacceptably high. [6]

If the tumor-to-breast ratio is sufficiently high to preclude a satisfactory cosmetic result with segmental excision, total mastectomy, with or without reconstruction, is an alternative. More radical procedures generally are not warranted. [24]

Axillary lymph node dissection should be performed only for clinically suspicious nodes. However, virtually all of these nodes are reactive and do not contain malignant cells. [27]

There is no proven role for adjuvant chemotherapy or radiation therapy in the treatment of phyllodes tumors. Response to chemotherapy and radiotherapy for recurrences and metastases has been poor, and no success with hormonal manipulation has been documented.


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