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Complete Pathologic Response Following Multimodality Therapy for a Recurrent, High-Grade Phyllodes Tumor

Nadia Ashai, Saranya Chumsri, Dina Kokh, Olga Ioffe, Zeljko Vujaskovic, Steven Feigenberg, Katherine Tkaczuk, Susan Beth Kesmodel


Introduction: Phyllodes tumor is a rare mesenchymal tumor of the breast for which surgical resection is the primary therapy. Despite adequate surgical resection, local recurrence rates of up to 40% are observed in patients with high-grade tumors. The role of adjuvant radiation therapy and chemotherapy for phyllodes tumor to improve local and systemic control is not well established. However, several small studies have shown improvements in local control rates with adjuvant radiation therapy. The management of aggressive local phyllodes tumor recurrences can be a clinical challenge and multimodality therapy should be considered in these cases for optimal results.

Case presentation: We present the case of a high-grade phyllodes tumor that recurred in the radiation field after adjuvant radiation therapy. The patient was treated with neoadjuvant hyperfractionated, accelerated radiotherapy in combination with hyperthermia and chemotherapy followed by radical surgical resection. A completed pathologic response was observed.

Conclusion: This multimodality approach may be a successful treatment algorithm for high-grade tumors that reoccur in a prior radiation field.


Phyllodes tumor; hyperfractionated accelerated radiotherapy; hyperthermia; sarcoma

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Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993, 71:3020-3024

Asoglu O, Ugurlu MM, Blanchard K, Grant CS, Reynolds C, Cha SS, Donohue JH. Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Annals of surgical oncology. 2004, 11:1011-1017

Pezner RD, Schultheiss TE, Paz IB. Malignant phyllodes tumor of the breast: Local control rates with surgery alone. International journal of radiation oncology, biology, physics. 2008, 71:710-713

Feigenberg SJ, Mendenhall NP, Reith JD, Ward JR, Copeland EM, 3rd. Angiosarcoma after breast-conserving therapy: Experience with hyperfractionated radiotherapy. International journal of radiation oncology, biology, physics. 2002, 52:620-626

Palta M, Morris CG, Grobmyer SR, Copeland EM, 3rd, Mendenhall NP. Angiosarcoma after breast-conserving therapy: Long-term outcomes with hyperfractionated radiotherapy. Cancer. 2010, 116:1872-1878

Eckert F, Matuschek C, Mueller AC, Weinmann M, Hartmann JT, Belka C, Budach W. Definitive radiotherapy and single-agent radiosensitizing ifosfamide in patients with localized, irresectable soft tissue sarcoma: A retrospective analysis. Radiation oncology. 2010, 5:55

Prosnitz LR, Maguire P, Anderson JM, Scully SP, Harrelson JM, Jones EL, Dewhirst M, Samulski TV, Powers BE, Rosner GL, Dodge RK, Layfield L, Clough R, Brizel DM. The treatment of high-grade soft tissue sarcomas with preoperative thermoradiotherapy. International journal of radiation oncology, biology, physics. 1999, 45:941-949

Issels RD, Lindner LH, Verweij J, Wust P, Reichardt P, Schem BC, Abdel-Rahman S, Daugaard S, Salat C, Wendtner CM, Vujaskovic Z, Wessalowski R, Jauch KW, Durr HR, Ploner F, Baur-Melnyk A, Mansmann U, Hiddemann W, Blay JY, Hohenberger P, European Organisation for R, Treatment of Cancer Soft T, Bone Sarcoma G, European Society for Hyperthermic O. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: A randomised phase 3 multicentre study. The Lancet. Oncology. 2010, 11:561-570

Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, Jung SP, Choe JH, Kim JH, Kim JS, Cho EY, Lee JE, Nam SJ, Yang JH. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Annals of surgical oncology. 2012, 19:2612-2617

Chen WH, Cheng SP, Tzen CY, Yang TL, Jeng KS, Liu CL, Liu TP. Surgical treatment of phyllodes tumors of the breast: Retrospective review of 172 cases. Journal of surgical oncology. 2005, 91:185-194

Belkacemi Y, Bousquet G, Marsiglia H, Ray-Coquard I, Magne N, Malard Y, Lacroix M, Gutierrez C, Senkus E, Christie D, Drumea K, Lagneau E, Kadish SP, Scandolaro L, Azria D, Ozsahin M. Phyllodes tumor of the breast. International journal of radiation oncology, biology, physics. 2008, 70:492-500

Gnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant phyllodes tumors: Analysis of the national cancer data base, 1998-2009. Annals of surgical oncology. 2014, 21:1222-1230

Barth RJ, Jr., Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Annals of surgical oncology. 2009, 16:2288-2294

Chaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE, Hunt KK. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000, 89:1502-1511

Hawkins RE, Schofield JB, Wiltshaw E, Fisher C, McKinna JA. Ifosfamide is an active drug for chemotherapy of metastatic cystosarcoma phyllodes. Cancer. 1992, 69:2271-2275

Burton GV, Hart LL, Leight GS, Jr., Iglehart JD, McCarty KS, Jr., Cox EB. Cystosarcoma phyllodes. Effective therapy with cisplatin and etoposide chemotherapy. Cancer. 1989, 63:2088-2092

Morales-Vasquez F, Gonzalez-Angulo AM, Broglio K, Lopez-Basave HN, Gallardo D, Hortobagyi GN, De La Garza JG. Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. The breast journal. 2007, 13:551-556

Wust P, Hildebrandt B, Sreenivasa G, Rau B, Gellermann J, Riess H, Felix R, Schlag PM. Hyperthermia in combined treatment of cancer. The Lancet. Oncology. 2002, 3:487-497

Overgaard J, Gonzalez Gonzalez D, Hulshof MC, Arcangeli G, Dahl O, Mella O, Bentzen SM. Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. European society for hyperthermic oncology. Lancet. 1995, 345:540-543

van der Zee J, Gonzalez Gonzalez D, van Rhoon GC, van Dijk JD, van Putten WL, Hart AA. Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: A prospective, randomised, multicentre trial. Dutch deep hyperthermia group. Lancet. 2000, 355:1119-1125

Jones EL, Oleson JR, Prosnitz LR, Samulski TV, Vujaskovic Z, Yu D, Sanders LL, Dewhirst MW. Randomized trial of hyperthermia and radiation for superficial tumors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005, 23:3079-3085

Lindner LH, Issels RD. Hyperthermia in soft tissue sarcoma. Current treatment options in oncology. 2011, 12:12-20


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