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LETTER TO THE EDITOR
Year : 2019  |  Volume : 15  |  Issue : 5  |  Page : 1194-1195

Effect of postoperative time for adjuvant radiotherapy in malignant phyllodes tumor: An institutional experience


Department of Radiation Oncology, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Date of Web Publication4-Oct-2019

Correspondence Address:
Veenita Yogi
Department of Radiation Therapy Gandhi Medical College, Bhopal - 462 001 Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_658_17

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How to cite this article:
Yogi V, Singh O P. Effect of postoperative time for adjuvant radiotherapy in malignant phyllodes tumor: An institutional experience. J Can Res Ther 2019;15:1194-5

How to cite this URL:
Yogi V, Singh O P. Effect of postoperative time for adjuvant radiotherapy in malignant phyllodes tumor: An institutional experience. J Can Res Ther [serial online] 2019 [cited 2019 Nov 13];15:1194-5. Available from: http://www.cancerjournal.net/text.asp?2019/15/5/1194/244470



Sir,

We read the article titled, “Extent of surgery in the management of phyllodes tumor of the breast: A retrospective multicenter study from India” by Verma et al. This study based on the data of surgical management of patients of phyllodes tumor at our institution. In reference to this study, we present the retrospective observational data of 13 patients who had been received adjuvant radiotherapy from the same institution.[1]

Cystosarcoma phyllodes tumors of the breast are uncommon fibroepithelial tumors composed of an epithelial and a cellular stromal component. They account for <1% of all breast neoplasms. These tumors can occur in women of all ages, including adolescents and elderly. They commonly arise in women between 35 and 55 years of age group.[2],[3] Cystosarcoma phyllodes tumors are capable of a diverse biologic behavior. In their least aggressive form, they behave similarly to benign fibroadenoma although with a propensity to recur locally following excision without wide margins. Virchow (1867) characterized this tumor as of limited malignancy but capable of metastasizing. Axillary node involvement is rare, but hematogenous spread of cystosarcoma occurs into lung, pleura, bone, and liver. The criteria for the diagnosis of malignant cystosarcoma phyllodes tumor include evidence of stromal outgrowth, hypercellularity, and an increase in the mitotic rate. The epithelial component of cystosarcoma phyllodes differentiates it from stromal sarcomas.[4] The terminology “phyllodes tumor” given by the World Health Organization classifies it into benign, borderline, and malignant tumors according to the histopathological features. Surgery has been the primary mode of treatment to date. However, the settings in which mastectomy might be preferred over local excision and those in which adjuvant radiotherapy might prove beneficial are unclear. This tumor does not respond to chemotherapy or hormonal therapy, and there is limited research available about radiotherapy and its effectiveness in reducing recurrence. The purpose of this study is to highlight the role of postoperative time of adjuvant radiotherapy in aggressive borderline and malignant phyllodes tumor.

A retrospective observational study of 13 patients with cystosarcoma phyllodes underwent surgical excision, wide local excision, or mastectomy for recurrent tumor. Data included for this study comprised of age at the diagnosis, clinical presentation, histological features, type of surgical procedure done, characteristics of locally recurrent disease, postoperative time of adjuvant radiotherapy, and patient follow-up. These data were analyzed and interpreted. SPSS software version 19 (IBM, New York, USA) was used for statistical analysis. All the 13 patients (three borderline and ten malignant) received adjuvant external beam radiotherapy (EBRT) dose of 50 Gy to the breast or chest wall, out of which eight patients received radiotherapy within 1 month of surgical procedure and five patients after 1 month.

After the completion of EBRT, the first follow-up was done after 1 month and every month up to 6 months and then every 3 months thereafter. Clinical examination was done at each visit. The median follow-up period was 9 months (range 2–38 months). At follow-up, the youngest patient in this study with preoperative tumor size 21 cm and histologically malignant, with high mitotic index and stromal activity, underwent mastectomy for recurrent tumor and received EBRT after 6 weeks of surgery, developed lung secondaries, and died within 3 months of treatment. All the patients who received EBRT within 1 month of surgery were not noticed local recurrence on follow-up, whereas two patients received EBRT after 1 month of surgery developed recurrence at local site at 9-month follow-up. The statistical analysis suggestive of significantly more recurrence in patients received EBRT after 1 month (P = 0.012).

Adjuvant radiotherapy for cystosarcoma phyllodes has been recommended by many authors for a combination of reasons, including bulky tumor volume, positive tumor margins, high mitotic index, high stromal activity, and recurrence. Margin-negative resection combined with adjuvant radiotherapy is very effective for local control and prevention of recurrence.[5]

Adjuvant radiotherapy is an appropriate treatment for aggressive borderline and malignant phyllodes tumor due to its unpredictable behavior of histological types and disputable results of particular surgical procedures. This study revealed that duration of initiation of EBRT after surgery plays a significant role in the prevention of recurrence. The value of the postoperative interval to EBRT for these patients will need to be confirmed in the future follow-up studies; however, more number of patients is needed for such recommendation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Verma S, Singh RK, Rai A, Pandey CP, Singh M, Mohan N, et al. Extent of surgery in the management of phyllodes tumor of the breast: A retrospective multicenter study from India. J Cancer Res Ther 2010;6:511-5.  Back to cited text no. 1
    
2.
Chaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer 2000;89:1502-11.  Back to cited text no. 2
    
3.
Joshi SC, Sharma DN, Bahadur AK, Maurya R, Kumar S, Khurana N, et al. Cystosarcoma phyllodes: Our institutional experience. Australas Radiol 2003;47:434-7.  Back to cited text no. 3
    
4.
Reinfuss M, Mituś J, Duda K, Stelmach A, Ryś J, Smolak K, et al. The treatment and prognosis of patients with phyllodes tumor of the breast: An analysis of 170 cases. Cancer 1996;77:910-6.  Back to cited text no. 4
    
5.
Barth RJ Jr., Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol 2009;16:2288-94.  Back to cited text no. 5
    




 

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