Prise en charge des tumeurs phyllodes malignes du sein : l’expérience de l’institut Curie |
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| Authors: | S Haberer M Laé V Seegers J-Y Pierga R Salmon YM Kirova R Dendale F Campana F Reyal O Miranda A Fourquet M-A Bollet |
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| Institution: | 1. Département de radiothérapie oncologique, institut Curie, 26, rue d’Ulm, 75248 Paris cedex 05, France;2. Département de biologie des tumeurs, institut Curie, 26, rue d’Ulm, 75248 Paris cedex 05, France;3. Département de biostatistiques, institut Curie, 26, rue d’Ulm, 75248 Paris cedex 05, France;4. Département d’oncologie médicale, institut Curie, 26, rue d’Ulm, 75248 Paris cedex 05, France;5. Département de chirurgie, institut Curie, 26, rue d’Ulm, 75248 Paris cedex 05, France;1. Service de gynécologie obstétrique, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France;2. Service de anatomo-pathologie, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France;3. Service de médecine interne, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France;4. Service de radiologie, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France;5. Université Paris-Sud, 63, rue Gabriel-Péri, 94270 Le-Kremlin-Bicêtre, France;6. Inserm U1018, CESP « reproduction et développement de l’enfant », 82, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France;7. Laboratoire de physique des interfaces et des couches minces, école polytechnique, 91128 Palaiseau, France;1. Service de Pathologie, Hôpital Abderrahman Mami, 2037 Ariana, Tunisie;2. Unité de recherche, 12SP18, Ariana, Tunisie;3. Service de Pneumologie, Pavillon IV, Hôpital Abderrahman Mami, Ariana, Tunisie;4. Service de Pneumologie, Pavillon II, Hôpital Abderrahman Mami, Ariana, Tunisie;5. Service de Radiologie, Hôpital Abderrahman Mami, Ariana, Tunisie;6. Service de Chrirugie Thoracique, Hôpital Abderrahman Mami, Ariana, Tunisie;1. Department of Medicine, European Institute of Oncology, Milan, Italy;2. Division of Breast Surgery, European Institute of Oncology, Milan, Italy;3. Division of Epidemiology and Biostatistics, Tumor Registry, European Institute of Oncology, Milan, Italy;4. Division of Pathology, European Institute of Oncology, Milan, Italy;5. University of Milan School of Medicine, Italy;2. Department of Radiology, MD Anderson Cancer Center, Houston, TX;3. Department of Pathology, Baylor College of Medicine, Houston, TX;1. CHU de Toulouse, service d’anatomie et de cytologie pathologiques, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France;2. Réseau de cancérologie de Midi-Pyrénées ONCOMIP, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France;3. Laboratoire d’anatomie et de cytologie pathologiques des feuillants, 116, route d’Espagne, 31000 Toulouse, France;4. Institut Claudius-Regaud, service d’anatomie et de cytologie pathologiques, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France;5. Clinique Claude-Bernard, service d’anatomie et de cytologie pathologiques, 1, rue Père-Colombier, 81030 Albi cedex 09, France;6. Laboratoire d’anatomie et de cytologie pathologiques, 13, rue Carnot, 65000 Tarbes, France;7. Laboratoire d’anatomie et de cytologie pathologiques, 9, rue Viscose, 31100 Toulouse, France;8. Laboratoire d’anatomie et de cytologie pathologiques de Montauban, 43, avenue Charles-de-Gaulle, 82000 Montauban, France;9. Laboratoire d’anatomie et de cytologie pathologiques, 62, boulevard des récollets, 31400 Toulouse, France;10. Centre de pathologie des coteaux, 5, rue Boyssonne, BP 14001, 31078 Toulouse cedex 4, France;11. Université Paul-Sabatier, département TIC/TICE et multimédia (DTSI), 118, route de Narbonne, 31062 Toulouse cedex 9, France;1. Division of Radiation Oncology, National Cancer Centre Singapore, Singapore;2. Division of Medical Oncology, National Cancer Centre Singapore, Singapore;3. Department of Surgery, Kandang Kerbau Women & Children Hospital, Singapore;4. Department of Pathology and Laboratory Medicine, Kandang Kerbau Women and Children Hospital, Singapore;5. Division of Pathology, Singapore General Hospital, Singapore |
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| Abstract: | PurposeGiven the scarcity of malignant phyllode tumours of the breast and the absence of consensus regarding their management justify the need for institutional retrospective evaluations of clinical practices.Patients and methodsRetrospective study with central pathology review of the 25 consecutive patients treated at the Institut Curie (Paris, France) between 1969 and 2006 for non metastatic malignant phyllodes tumors of the breast. The median follow-up was 65 months (7–257 months).ResultsMedian age at diagnosis was 52 years (20–64 years). Breast surgery was conservative in five patients (20%). Surgical margins were wide (> 10 mm), narrow, involved or unknown in respectively 17 (68%), three (12%), three (12%) and two (8%) patients. Median tumour size was 65 mm (12–250 mm). Adjuvant radiotherapy was delivered in seven (28%) patients (two patients, posttumorectomy; five patients, postmastectomy) and 13 patients (52%) received anthracycline-based adjuvant chemotherapy. Five-year overall survival rate was 91% (95% CI, 80–100%). Five patients (20%) developed distant metastases (one after chemotherapy) and three (12%) locoregional relapse (one after tumorectomy and unknown margin without radiotherapy, two after mastectomy and involved margins with radiotherapy).ConclusionWide breast surgery (that can be conservative in selected patients) is the mainstay of the treatment of non metastatic malignant phyllodes tumors of the breast. To better determine the respective roles of adjuvant systemic treatment and radiotherapy, further clinical studies and the search for new prognostic and predictive factors remain necessary. |
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