Multidisciplinary management of phyllodes tumours and breast sarcoma : a cross-sectional survey of clinical practice across the United Kingdom and Ireland

Bishr, Mai K. and Banks, Jenny and Abdelaziz, Mohamed S. and Badawi, Marwa and Crane, Peter W. and Donigiewicz, Urszula Joanna and Elkorety, Mohamed and Girgis, Mina and Humphreys, Alex and Isherwood, Jen and Kahan, Jennifer and Keelan, Stephen and Lindqvist, Ebba K. and Nixon, Ioanna and Sackey, Helena and Sars, Carl and Soliman, Hesham and Touqan, Nader and Remoundos, Dionysios Dennis and Ahmed, Mahbubl (2024) Multidisciplinary management of phyllodes tumours and breast sarcoma : a cross-sectional survey of clinical practice across the United Kingdom and Ireland. Clinical Oncology, 36 (1). e31-e39. ISSN 0936-6555 (https://doi.org/10.1016/j.clon.2023.10.050)

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Abstract

Aims: Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. Materials and methods: An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. Results: Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14–21% of the MDTs and the most recommended resection margins for breast surgery were ‘no tumour on ink’ in benign phyllodes (39%) and 10 mm in the remaining subtypes (25–29%). Immediate breast reconstruction was supported by 11–18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. Conclusion: The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.

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