Manejo clínico, tratamiento y control local del tumor phyllodes mamario

Abstract

AimTo describe the clinical and surgical management of phyllodes tumors in our center in the last 13 years, as well as local tumor control, according to tumoral grade. Material and methodWe performed a retrospective study of all patients with a diagnosis of phyllodes tumor (N=34) in the Pathology Department of Hospital Clínico San Carlos in Madrid between 1997 and 2010. The clinical and pathological factors that could influence recurrence and disease-free survival were analyzed. ResultsThe mean age of the patients at diagnosis was 41 years (±13.3). Conservative surgery was initially performed in all patients (N=34) and reoperation in 17 (50.0%). Mastectomies were performed in 7 patients: 5 simple mastectomies and 2 mastectomies with axillary lymphadenectomy. Three mastectomies were performed for benign phyllodes tumor and large tumor size (12%), with good cosmetic outcome, and 2 mastectomies were performed for malignant phyllodes tumors (33.3%). In the remaining 2 patients, mastectomy plus axillary lymphadenectomy was performed for a malignant phyllodes tumor with aggressive histology in one patient and for a recurrent, bulky, benign phyllodes tumor in the other. There was no evidence of disease in either of the 2 axillary dissections. In the univariate analysis, significant differences in histological necrosis were found in malignant phyllodes tumors. Local recurrences occurred in 8 patients (23.5%) mainly during the first 2 years of follow up. ConclusionOur main objective was to achieve larger safety margins (of at least 1cm) through surgery (mastectomy or conservative surgery), leading to reoperation in some patients. In histologically-aggressive malignant phyllodes tumors, mastectomy and adjuvant radiotherapy were required to achieve better disease control.