Kefah Mokbel: Update on the Management of Phyllodes Tumours
Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“Update on the management of phyllodes tumours
Preoperative Staging
• Preoperative low dose thoracic CT or PET scan is recommended for patients with malignant PT
Surgery
• Benign PT: complete excision with the capsule intact is adequate.
• Borderline/malignant PT: ≥5 mm margin required.
• Immediate breast reconstruction is safe.
Adjuvant radiotherapy
• Not recommended for benign PT (III/A).
• Borderline PT: generally not recommended; may be considered in high-risk cases (large tumours, infiltrative borders, or positive/close margins when re-excision is not feasible) (III/A).
• Malignant PT:
• Consider in large (>5 cm) or multifocal tumours (II/A).
• In small solitary tumours, consider only if clear 5 mm margins cannot be achieved and further surgery is not possible; re-excision preferred (V/B).
• In recurrent disease, consider after re-excision if not previously given (V/B).
• Recommended dose: 50–66 Gy; hypofractionation may be considered (II/B, IV/B).
• TP53 testing should be considered before radiotherapy to assess secondary malignancy risk (III/B).
Adjuvant chemotherapy
• Not recommended in non-metastatic PT.
Follow up surveillance
• Benign PT: routine breast screening
• Borderline PT: clinical exam every 6 months for 3 years, ultrasound every 6 months for 3 years, and annual mammography (aged 40+years) .
• Malignant PT: clinical exam every 6 months for 3 years, then annually in years 4–5; ultrasound every 6 months for 3 years and annual mammography (aged+40 years) chest imaging (chest-Xray or low dose CT) every 6 months for 2 years, then annually in years 3–5.”
Title: Contemporary management of phyllodes tumours of the breast: recommendations from the UK Association of Breast Surgery
Authors: Mai K Bishr, Alex Humphreys, Mahbubl Ahmed, Karina Cox, Adam Hughes, Jen Isherwood, Sarah E Pinder, Dionysios D Remoundos, Elinor Sawyer, Muhammad S Tamimy, Lisa Whisker
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