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Utilization of Radiotherapy for Malignant Phyllodes Tumors: Analysis of the National Cancer Data Base, 1998–2009



Malignant phyllodes tumors of the breast have traditionally been treated with surgical excision. Recently, the use of adjuvant radiotherapy has been advocated to reduce the risk of local recurrence; however, this recommendation is controversial in the absence of consistent outcome data. We hypothesize that there has been a trend toward increased utilization of adjuvant radiotherapy for malignant phyllodes tumors despite its uncertain effect on outcomes.


Using the National Cancer Data Base, predictors of radiotherapy utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan–Meier and Cox regression models were generated to determine the effect of radiotherapy on local recurrence (LR), disease-free survival (DFS), and overall survival (OS).


Of the 3,120 patients with malignant phyllodes, 57 % underwent breast conservation surgery and 42 % underwent mastectomy. Overall, 14.3 % of women received adjuvant radiotherapy. Utilization of radiotherapy doubled over the study period (9.5 % in 1998–1999 vs. 19.5 % in 2008–2009, p < 0.001). Women were significantly more likely to receive radiotherapy if they were diagnosed later in the study, were age 50–59 years old, had tumors >10 cm, or had lymph nodes removed. For the 1,774 patients with available recurrence data, overall recurrence was 14.1 %, and LR was 5.9 %. In adjusted models, adjuvant radiotherapy reduced LR (aHR 0.43, 95 % CI 0.19–0.95) but did not impact DFS or OS after 53 months’ median follow-up.


Utilization of adjuvant radiotherapy for malignant phyllodes doubled from 1998 to 2009. Radiotherapy significantly reduced LR but had no effect on DFS or OS.

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  1. 1.

    Rowell MD, Perry RR, Hsiu JG, Barranco SC. Phyllodes tumors. Am J Surg. 1993;165:376–9.

  2. 2.

    Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases. Histopathology. 1995;27:205–18.

  3. 3.

    Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910–6.

  4. 4.

    World Health Organization. Histological typing of breast tumors. Tumori. 1982;68:181–98.

  5. 5.

    Guillot E, Couturaud B, Reyal F, et al. Management of phyllodes breast tumors. Breast J. 2011;17:129–37.

  6. 6.

    Tan PH, Jayabaskar T, Chuah KL, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005;123:529–40.

  7. 7.

    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.

  8. 8.

    Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 1999;57:291–5.

  9. 9.

    Tan PH, Thike AA, Tan WJ, et al. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 2012;65:69–76.

  10. 10.

    Abdalla HM, Sakr MA. Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J Egypt Natl Cancer Inst. 2006;18:125–33.

  11. 11.

    Ellis I, Sawyer EJ, Rampaul R, Pineda CG. Phyllodes tumor of the breast. In: Raghavan D, Brecher ML, Johnson DH, Merpol NJ, Moots PL, Rose PG, editors. Textbook of uncommon cancer. 3rd edition. Chichester: Wiley; 2006. p. 209–17.

  12. 12.

    Chaney AW, Pollack A, McNeese MD, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000;89:1502–11.

  13. 13.

    Asoglu O, Ugurlu MM, Blanchard K, et al. Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol. 2004;11:1011–7.

  14. 14.

    Pezner RD, Schultheiss TE, Paz IB. Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 2008;71:710–3.

  15. 15.

    Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. 2001;77:428–35.

  16. 16.

    Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006;107:2127–33.

  17. 17.

    Belkacemi Y, Bousquet G, Marsiglia H, et al. Phyllodes tumor of the breast. Int J Radiat Oncol Biol Phys. 2008;70:492–500.

  18. 18.

    Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91:185–94.

  19. 19.

    Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ, Souba WW. Surgical management of phyllodes tumors. Arch Surg. 1999;134:487–92.

  20. 20.

    Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol. 2001;27:723–30.

  21. 21.

    Barrio AV, Clark BD, Goldberg JI, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961–70.

  22. 22.

    Carlson RW, Allred DC, Anderson B, et al. The NCCN breast cancer clinical practices guidelines in oncology, version 2. Available at: Accessed July 13, 2012.

  23. 23.

    Soumarova R, Seneklova Z, Horova H, et al. Retrospective analysis of 25 women with malignant cystosarcoma phyllodes—treatment results. Arch Gynecol Obstet. 2004;269:278–81.

  24. 24.

    Chaney AW, Pollack A, McNeese MD, Zagars GK. Adjuvant radiotherapy for phyllodes tumor of breast. Radiat Oncol Investig. 1998;6:264–7.

  25. 25.

    Pandey M, Mathew A, Kattoor J, et al. Malignant phyllodes tumor. Breast J. 2001;7:411–6.

  26. 26.

    Hopkins ML, McGowan TS, Rawlings G, et al. Phylloides tumor of the breast: a report of 14 cases. J Surg Oncol. 1994;56:108–12.

  27. 27.

    McGowan TS, Cummings BJ, O’Sullivan B, Catton CN, Miller N, Panzarella T. An analysis of 78 breast sarcoma patients without distant metastases at presentation. Int J Radiat Oncol Biol Phys. 2000;46:383–90.

  28. 28.

    Winchester DP, Stewart AK, Bura C, Jones RS. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol. 2004;85:1–3.

  29. 29.

    Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15:683–90.

  30. 30.

    Commission on Cancer. Categories of Accreditation. Available at: Accessed January 20, 2012.

  31. 31.

    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.

  32. 32.

    Fritz A, Percy C, Jack A, et al, eds. ICD-O: international classification of disease for oncology. 3rd edition. Geneva: World Health Organization; 2000.

  33. 33.

    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

  34. 34.

    Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14:859–68.

  35. 35.

    Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.

  36. 36.

    O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235–41.

  37. 37.

    Ben Hassouna J, Damak T, Gamoudi A, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg. 2006;192:141–7.

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The authors declare no conflict of interest.

Author information

Correspondence to Swati A. Kulkarni MD.

Additional information

Jennifer L. Gnerlich and Richelle T. Williams have contributed equally to this study.

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Gnerlich, J.L., Williams, R.T., Yao, K. et al. Utilization of Radiotherapy for Malignant Phyllodes Tumors: Analysis of the National Cancer Data Base, 1998–2009. Ann Surg Oncol 21, 1222–1230 (2014).

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  • Overall Survival
  • Adjuvant Radiotherapy
  • Breast Conservation Surgery
  • Phyllode Tumor
  • National Cancer Data Base