TY - JOUR

T1 - Current clinical practice in the management of phyllodes tumors of the breast

T2 - an international cross-sectional study among surgeons and oncologists

AU - Sars, Carl

AU - Sackey, Helena

AU - Frisell, Jan

AU - Dickman, Paul W.

AU - Karlsson, Fredrik

AU - Kindts, Isabelle

AU - Marta, Gustavo Nader

AU - Freitas-Junior, Ruffo

AU - Tvedskov, Tove Filtenborg

AU - Kassem, Loay

AU - Ali, Ahmed S.

AU - Ihalainen, Hanna

AU - Neron, Mathias

AU - Kontos, Michalis

AU - Kaidar-Person, Orit

AU - Meattini, Icro

AU - Francken, Anne Brecht

AU - van Duijnhoven, Frederieke

AU - Moberg, Ingvild Ona

AU - Marinko, Tanja

AU - Kollar, Attila

AU - Ahmed, Mahbubl

AU - Remoundos, Dennis

AU - Banks, Jenny

AU - Jagsi, Reshma

AU - Dossett, Lesly A.

AU - Lindqvist, Ebba K.

N1 - Funding Information: 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. Publisher Copyright: © 2023, The Author(s).

PY - 2023/6

Y1 - 2023/6

N2 - 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.

AB - 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.

KW - Breast neoplasms

KW - Margins of excision

KW - Phyllodes tumor

KW - Surgical oncology

U2 - 10.1007/s10549-023-06896-1

DO - 10.1007/s10549-023-06896-1

M3 - Journal article

C2 - 36879102

AN - SCOPUS:85149419357

VL - 199

SP - 293

EP - 304

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

IS - 2

ER -