title: Current Trends in the Management of Phyllodes Tumors of the Breast.
abstract: National Comprehensive Cancer Network (NCCN) guidelines recommend wide excision without axillary staging to treat phyllodes tumors of the breast. Without prospective trials to guide management, NCCN also recommends consideration of radiation therapy (XRT). We describe current patterns of care for the multidisciplinary management of phyllodes tumors.
  
  
  
  Using Surveillance, Epidemiology, and End Results Program (SEER) data, we identified women diagnosed with phyllodes tumors between 2000 and 2012 who underwent surgical therapy. Trends in breast-conserving surgery (BCS), nodal sampling, and XRT were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to identify factors associated with treatment.
  
  
  
  Of 1238 patients, 56.9 % underwent BCS and 23.6 % underwent nodal sampling (10.5 % after BCS vs. 40.9 % after mastectomy). After surgery, 15.4 % received adjuvant XRT (BCS 12.9 %, and mastectomy 18.8 %). XRT utilization increased significantly over the study period (BCS, p = < 0.0001; mastectomy, p = 0.0003), while nodal sampling did not change significantly. Women were more likely to receive mastectomy if they were older or had larger tumors. Nodal sampling was also associated with older age, larger tumor size, and receipt of mastectomy. Receipt of XRT was associated with later year of diagnosis, larger tumors, and nodal assessment.
  
  
  
  Over time, an increasing number of women received XRT after surgical management of phyllodes tumor, and one in four women underwent nodal sampling. While some of this practice can be attributed to concern about more advanced disease in the absence of strong data, there may be an educational gap regarding current guidelines and appropriate management.
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
authors.forename: Taiwo
authors.initials: T
authors.lastname: Adesoye
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.|Division of Surgical Oncology, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
authors.forename: Lee G
authors.initials: LG
authors.lastname: Wilke
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steiman
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA. greenberg@surgery.wisc.edu.|Division of Surgical Oncology, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA. greenberg@surgery.wisc.edu.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D001706:Biopsy / Q000639:trends; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D015412:Mastectomy, Segmental / Q000639:trends*; D008875:Middle Aged; D003557:Phyllodes Tumor / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000639:trends; D018426:SEER Program; D047368:Tumor Burden; D014481:United States