title: Malignant and borderline phyllodes tumor of breast treated with a multi-modality approach in a tertiary cancer care centre in North India.
abstract: BACKGROUND
  Phyllodes tumor (PT) of the breast can be categorized into benign, borderline and malignant subgroups depending on various histopathological factors. Although malignant PTs may be indolent and controlled by local excision, they frequently show local and distant relapses. Literature reveals local recurrence to be the predominant pattern of failure and thus emphasizes the importance of adjuvant radiation in these tumors. The role of systemic chemotherapy has remained doubtful.
  
  
  METHODS
  We have analyzed details of all patients of PT (n = 33) treated with adjuvant multi-modality approach in our institute since 1994-2009. The demographic data, treatment details, recurrence patterns and salvage treatment options were documented.
  
  
  RESULTS
  All patients received adjuvant radiation. Seven patients received adjuvant chemotherapy. The mean survival of the entire cohort was 150.618 months. There was a trend for better overall survival with borderline grade (193.6 vs. 160.2 months; P = 0.08, log rank). The disease free survival (DFS) favored borderline grade (193.6 months vs. 82.9 months for high grade; P = 0.02, log rank). The DFS was significantly better in tumors having negative margins on postoperative histopathological examination (DFS rate at 5 years being 100% vs. 69.2% for positive or close margins; P = 0.015). The mode of surgery did not have any impact on survival.
  
  
  CONCLUSIONS
  Adjuvant Radiation should be discussed taking into account surgical margins, size and various pathological factors of the primary. Adjuvant radiation may be utilized in high risk patients to enhance loco-regional control. Systemic chemotherapy is an option, worth exploring, in cases of systemic failure.
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Joshi
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Soumyajit
authors.initials: S
authors.lastname: Roy
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Ajeet Kumar
authors.initials: AK
authors.lastname: Gandhi
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Pandit
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Dayanand
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Julka
authors.affiliation: Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India.
authors.forename: Goura Kishore
authors.initials: GK
authors.lastname: Rath
keywords: Adjuvant radiation; borderline; malignant; phyllodes tumors; systemic chemotherapy