Phyllodes tumor of breast
ICD-10 D48.6 · ICD-11 2C63

Treatment of Malignant Phyllodes Tumour of Breast With No Distant Metastasis

This protocol applies to patients presenting with a confirmed malignant phyllodes tumour of the breast in the absence of distant metastatic spread. Malignant phyllodes tumours represent a distinct minority of all phyllodes tumour diagnoses and require a specifically tailored management approach.

Clinical scenario

Malignant phyllodes tumours account for roughly 20–30% of all phyllodes tumour cases. These biphasic tumours — carrying both stromal and epithelial components — are classified across three groups (benign, borderline, and malignant), and management must reflect the specific histological classification and extent of disease.

This protocol addresses the malignant subtype with no distant metastasis, where local-regional control is the primary treatment objective.

Treatment approach (partial overview)

The evidence-based approach for this scenario involves consideration of adjuvant radiotherapy under specific tumour-related criteria — including tumour size and disease focality — as well as margin status. The full protocol specifies the indication criteria, dose framework, fractionation options, and clinical decision points for when surgery versus radiotherapy should take precedence.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/bjs/znaf152

  • PT are biphasic with both stromal and epithelial components and are classified into three groups with the following proportions: benign, 50–70%; borderline, 12–26%; and malignant, 20–30%.
  • In malignant PT, adjuvant radiotherapy should be considered in large tumours (>5 cm) and in multifocal disease (evidence/grade II/A).
  • In solitary smaller malignant PT, radiotherapy may be considered if a surgical margin of 5 mm was not achieved and further surgery is not possible. Repeat surgery to achieve clear margins is preferable to adjuvant radiotherapy (evidence/grade V/B).
  • The consensus recommendation for adjuvant radiotherapy dose is 50–66 Gy (evidence/grade II/B) and hypofractionated regimens to an equivalent dose could be considered (evidence/grade IV/B).
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