Charoenyothakun Amonthep, Shotelersuk Kanjana, Nantavithya Chonnipa, Saksornchai Kitwadee
Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Breast Cancer. 2025 May 22. doi: 10.1007/s12282-025-01725-3.
BACKGROUND: Borderline and malignant phyllodes tumors (PTs) are rare fibroepithelial breast neoplasms associated with a high risk of locoregional recurrence (LRR). Although adjuvant radiation therapy (RT) is increasingly used, its clinical benefit remains uncertain. This study aimed to assess the impact of RT and identify factors associated with LRR in patients with borderline and malignant PTs. METHODS: A retrospective review was conducted on 102 patients (50 borderline, 52 malignant PTs) who underwent surgery between 2012 and 2021. Clinical, pathological, and treatment data were analyzed. The primary endpoint was LRR. Kaplan-Meier and Cox regression models were used to assess recurrence and risk factors. RESULTS: Median follow-up was 4.3 years. Malignant PTs were more likely to be > 10 cm (63.5% vs. 22%), undergo mastectomy (75% vs. 11%), and receive adjuvant RT (78.9% vs. 8%) compared to borderline PTs (all P < 0.001). Among patients without RT, malignant PTs had a significantly higher LRR than borderline PTs (36.4% vs. 4.4%, P < 0.010). In malignant PTs, RT was associated with a lower LRR (12.2% vs. 36.4%), though not statistically significant (P = 0.081). Tumor subtype was the only independent predictor of LRR (P = 0.011). Among malignant PTs who received RT, treatment initiation beyond 12 weeks post-surgery was associated with increased LRR (P = 0.009). Radiation technique, dose, and use of bolus were not significantly associated with LRR. CONCLUSION: Malignant PTs demonstrated higher LRR than borderline PTs. While the benefit of RT was not statistically significant, a trend toward reduced recurrence was observed.
背景：交界性和恶性叶状肿瘤（PTs）是罕见的乳腺纤维上皮性肿瘤，与局部区域复发（LRR）的高风险相关。尽管辅助放疗（RT）的使用越来越多，但其临床益处仍不确定。本研究旨在评估放疗的影响，并确定交界性和恶性PTs患者中与LRR相关的因素。 方法：对2012年至2021年间接受手术的102例患者（50例交界性PTs，52例恶性PTs）进行回顾性研究。分析临床、病理和治疗数据。主要终点是LRR。采用Kaplan-Meier和Cox回归模型评估复发情况和危险因素。 结果：中位随访时间为4.3年。与交界性PTs相比，恶性PTs更有可能大于10 cm（63.5%对22%）、接受乳房切除术（75%对11%）和接受辅助放疗（78.9%对8%）（所有P<0.001）。在未接受放疗的患者中，恶性PTs的LRR显著高于交界性PTs（36.4%对4.4%，P<0.010）。在恶性PTs中，放疗与较低的LRR相关（12.2%对36.4%），但无统计学意义（P=0.081）。肿瘤亚型是LRR的唯一独立预测因素（P=0.011）。在接受放疗的恶性PTs中，术后12周后开始治疗与LRR增加相关（P=0.009）。放疗技术、剂量和使用推注与LRR无显著相关性。 结论：恶性PTs的LRR高于交界性PTs。虽然放疗的益处无统计学意义，但观察到复发有减少的趋势。
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