Phyllodes Tumor Page 1 of 4

Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,
and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to
determine a patient's care. This algorithm should not be used to treat pregnant women.
Note: Consider Clinical Trials as treatment options for eligible patients.

PATIENT INITIAL TREATMENT

PRESENTATION EVALUATION
Fibroadenoma Close clinical follow-up

Review final pathology

Clinical suspicion of ● History and
Phyllodes tumor ● If benign or borderline, observe
phyllodes tumor: physical exam
includes benign4, Wide excision4 without ● If malignant, consider radiation therapy
5,6,7
● Palpable mass ● Ultrasound
borderline and axillary staging ● If greater than 5 cm with stromal
● Rapid growth ● Mammogram for
Core needle malignant5,6 overgrowth, refer to Adult Soft – Tissue
● Imaging with ultrasound women greater
biopsy2,3 Sarcoma for Clinical Stage III algorithm
suggestive of fibroadenoma than or equal to
except for size (greater than 30 years of age
2 cm) and/or history of ● Lifestyle risk
rapid growth assessment1 Invasive or in situ See Breast cancer - Invasive
breast cancer or Noninvasive algorithms

Phyllodes, including benign,

Fibroepithelial
borderline and malignant
lesion or Excisional Review final
indeterminate biopsy8 pathology
pathology3 Fibroadenoma Observation

1
See Physical Activity, Nutrition, and Tobacco Cessation algorithms; ongoing reassessment of lifestyle risks should be a part of routine clinical practice
2
Fine needle aspiration will not, and core biopsy may not, distinguish fibroadenoma from phyllodes tumor in most cases (tumor heterogenity and inability to assess for infiltrating margins may not allow for a definitive evaluation)
3
It is recommended that the review of the pathology material be performed by a pathologist who is experienced in phyllodes tumor
4
If initially excised with negative margin, wide local excision not required
5
Referral to a multidisciplinary sarcoma center for treatment recommendations is appropriate for malignant phyllodes tumor or one with stromal overgrowth
6
For patients with malignant phyllodes tumor on pathology review, refer to Adult Soft - Tissue Sarcoma for Clinical Stage III algorithm
7
There is no prospective randomized data supporting the use of radiation treatment (XRT) with phyllodes tumor. If the phyllodes tumor of the breast is benign or borderline histology, radiation therapy not routinely recommended after excision.
If the tumor has malignant features (i.e., stromal overgrowth, cellular atypia, high number of mitoses) radiation therapy can be considered as follows:
● If mastectomy is performed and margins negative, do not recommend XRT
● If mastectomy was performed and margins were concerning/close, tumor involved the fascia or chest wall, or tumor was very large (greater than 5 centimeters), consider XRT to chest wall
● If partial mastectomy only is performed, consider adjuvant XRT to breast, especially if margins are less than 1 cm
8
Excisional biopsy includes complete mass removal, but without the intent of obtaining widely negative surgical margins

Department of Clinical Effectiveness V8

Approved by Executive Committee of the Medical Staff on 07/30/2019
 Phyllodes Tumor Page 2 of 4
Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,
and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to
determine a patient's care. This algorithm should not be used to treat pregnant women.
Note: Consider Clinical Trials as treatment options for eligible patients.

PATIENT INITIAL TREATMENT

PRESENTATION EVALUATION

No metastatic Consider post-

Re-excision with histologically negative
disease operative radiation
margins without axillary staging
(category 2B)2
● History and physical exam
● Ultrasound
Locally recurrent breast
● Mammogram
mass following excision 1
● Core needle biopsy
of phyllodes tumor
● Consider chest imaging if
malignant phyllodes tumor

Metastatic disease management following principles of soft tissue sarcoma

Metastatic disease
(see Adult Soft – Tissue Sarcoma for Clinical Stage III algorithm)

1
Pathology should be reviewed to assess for fibroadenoma versus phyllodes (phyllodes benign, borderline and malignant).
2
There is no prospective randomized data supporting the use of radiation treatment with phyllodes tumor . However, in the setting where additional recurrence would create significant morbidity (e.g., chest wall
recurrence following salvage mastectomy) radiation therapy may be considered, following the same principles that are applied to the treatment of soft tissue sarcoma. Radiation therapy is considered for malignant
phyllodes tumor after wide local excision lesions over 2 cm or after mastectomy for lesions over 5 cm based on the retrospective review of 478 patients analyzed by Pezner, et al., 2008.

Department of Clinical Effectiveness V8

Approved by Executive Committee of the Medical Staff on 07/30/2019
 Phyllodes Tumor Page 3 of 4
Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,
and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to
determine a patient's care. This algorithm should not be used to treat pregnant women.

SUGGESTED READINGS

National Comprehensive Cancer Network. (2018). Breast Cancer (NCCN Guideline Version 4.2018). Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/
breast.pdf
Pezner, R. D., Schultheiss, T. E., & Paz, I. B. (2008). Malignant phyllodes tumor of the breast: Local control rates with surgery alone. International Journal of Radiation Oncology,
Biology, Physics, 71(3), 710-713. doi: 10.1016/j.ijrobp.2007.10.051

Department of Clinical Effectiveness V8

Approved by Executive Committee of the Medical Staff on 07/30/2019
 Phyllodes Tumor Page 4 of 4
Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,
and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to
determine a patient's care. This algorithm should not be used to treat pregnant women.

DEVELOPMENT CREDITS

This practice algorithm is based on majority expert opinion of the Breast Center Faculty at the University of Texas MD Anderson Cancer Center. It was developed using a multidisciplinary
approach that included input from the following:

Constance Albarracin, MD (Anatomical Pathology) Ashleigh Guadagnolo, MD, MPH (Radiation Oncology)Ŧ George H. Perkins, MD (Radiation Oncology)
Dejka M. Araujo, MD (Sarcoma Medical Oncology) Karen Hoffman, MD (Radiation Oncology) Vinod Ravi, MD (Sarcoma Medical Oncology)
Elsa Arribas, MD (Diag Rad – Breast Imaging) Gabriel N. Hortobagyi, MD (Breast Medical Oncology) Erika Resetkova, MD (Anatomical Pathology)
Banu K. Arun, MD (Breast Medical Oncology) Kelly K. Hunt, MD (Breast Surgical Oncology)Ŧ Geoffrey L. Robb, MD (Plastic Surgery)
Gildy Babiera, MD (IT Cancer Network) Rosa F. Hwang, MD (Breast Surgical Oncology) Merrick I. Ross, MD (Surgical Oncology)
Robert C. Bast Jr., MD (Translational Research) Nuhad K. Ibrahim, MD (Breast Medical Oncology) Aysegul A. Sahin, MD (Pathology Admin)
Isabelle Bedrosian, MD (Breast Surgical Oncology)Ŧ Kimberly B. Koenig, MD (Breast Medical Oncology) Lumarie Santiago, MD (Diag Rad – Breast Imaging)
Robert S. Benjamin, MD (Sarcoma Medical Oncology) Pauline Koinis, BSMT♦ Simona F. Shaitelman, MD (Radiation Oncology)
Shon Black, MD (Breast Surgical Oncology) Savitri Krishnamurthy, MD (Pathology Admin) Benjamin Smith, MD (Radiation Oncology)
Daniel J. Booser, MD (Breast Medical Oncology) Henry M. Kuerer MD, PhD (Breast Surgical Oncology)Ŧ Eric A. Strom, MD (Radiation Oncology)
Abenaa Brewster, MD (Clinical Cancer Prevention) Deanna L. Lane, MD (Diag Rad – Breast Imaging) W. Fraser Symmans, MD (Anatomical Pathology)
Thomas A. Buchholz, MD (Radiation Oncology)Ŧ Huong Carisa Le-Petross, MD (Diag Rad – Breast Imaging) Welela Tereffe, MD (Radiation Oncology)Ŧ
Aman U. Buzdar, MD (Clinical Research) Jennifer Litton, MD (Breast Medical Oncology) Debu Tripathy, MD (Breast Medical Oncology)Ŧ
Abigail S. Caudle, MD (Breast Surgical Oncology) Anthony Lucci, MD (Breast Surgical Oncology) Naoto T. Ueno, MD (Breast Medical Oncology)
Janice N. Cormier, MD (Surgical Oncology) Joseph A. Ludwig, MD (Sarcoma Medical Oncology) Vincente Valero, MD (Breast Medical Oncology)
Sarah M. DeSnyder, MD (Breast Surgical Oncology) Funda Meric-Bernstam, MD (Invest. Cancer Therapeutics) Ronald Walters, MD (Institute of Cancer Care Innovation)
Mark J. Dryden, MD (Diag Rad – Breast Imaging) Lavinia P. Middleton, MD (Anatomical Pathology) Gary J. Whitman, MD (Diag Rad – Breast Imaging)
Barry W. Feig, MD (Surgical Oncology) Tamara Miner Haygood, MD (Diag Rad – Musculoskeletal Imaging) Wendy Woodward, MD (Radiation Oncology)
Bruno D. Fornage, MD (Diag Rad – Breast Imaging) Stacy Moulder, MD (Breast Medical Oncology) Wei Yang, MD (Diag Rad)
Sharon H. Giordano, MD (Health Svcs Research – Clinical) Shreyaskumar Patel, MD (Sarcoma Medical Oncology)

Ŧ
Core Development Team
♦ Clinical Effectiveness Development Team
Department of Clinical Effectiveness V8
Approved by Executive Committee of the Medical Staff on 07/30/2019