1. CTOS 2009 15 years Experience of Management of Malignant Phyllodes Tumor and Breast Sarcoma at Princess Margaret Hospital Princess Margaret Hospital & Mount Sinai Hospital University of Toronto Nikhilesh Patil, Charles Catton, Brian O’Sullivan, Robert Dinniwell, Anthony Griffin, Peter C Ferguson, Rebecca Gladdy, David McCready, Martin Blackstein, Abha Gupta, Lisa W Le, Peter Chung

2. CTOS 2009 Purpose To report the outcomes of Malignant phyllodes tumors (MPT) and breast sarcomas (BS)

3. CTOS 2009 Methods Retrospective review (Jan 1991 to Dec 2006) N = 111 3 Groups 1) MPT :75 (68%) 2) Angiosarcomas:22 (18%) 3) Others:14 (14%) Grade: Low : 29 (26%) Intermediate : 10 (9%) High : 48 (43%) NOS : 24 (22%)

4. CTOS 2009 Histologic subtypes Malignant phyllodes : 75 (68%) Angiosarcomas : 22 (18%) Sarcoma NOS : 7 (7%) Fibrosarcoma : 3 (3%) Leiomyosarcoma : 1 (1%) Liposarcoma: 1 (1%) Mxyoid NOS : 1 (1%) Alvelolar RMS : 1 (1%)

5. CTOS 2009 Surgical details Mastectomy alone: 47 (42%) Mastectomy +RT: 34 (31%) Wide local excision/Lumpectomy alone: 11 (10%) Wide local excision +RT: 17 (15%) Margin: » Negative : 84 (76%) » Close (<1cms) : 12 (11%) » Positive: 13 (12%) 2 patients were not offered sx (1 alveolar RMS because of no residual disease after chemotherapy and other large tumor with bleeding – palliative RT)

6. CTOS 2009 RT details Rationale for RT : Close/+ margins in lumpectomy/mastectomy (usually deep margin in absence of removal of pectoral fascia). We consider wide margin to be >1-2cm. N : 53 (48%) Indication »Adjuvant RT : 41(lumpectomy = 16, mastectomy = 25), » Recurrent disease : 3 » Palliative : 6 » Pre-op RT : 3 Technique »Tangents : 41 » IMRT : 5 » Others : 6 Median dose: 50 GY (range 20-63)

7. CTOS 2009 Results Median age: 47 yrs (range 17- 83) Median tumor size: 5cms (range 0.5 – 27) Median follow up: 5.2 yrs (range 0.1 – 18.8 yrs) Controlled (local+distant) : 71( 64%) Local relapse : 4 ( 4%) Distant relapse : 36 (32%) 10 patients had prior radiation (angiosarcomas) following surgery for breast cancer. Therefore did not have further rads.

8. CTOS 2009 5 years OS: 71% (95%CI: 61-80) 5 years PFS : 64% (95%CI: 54-74)

9. CTOS 2009 P <0.0001 1 = MPT 2= Angiosarc 3= Others

10. CTOS 2009 No local failure following adjuvant RT. Four (3%) has local recurrence without adjuvant RT (3 angiosarcomas and 1 MPT)

11. CTOS 2009 Univariate and Multivariate Analysis OASPFS HR(95%CI)UniMultiHR(95%CI)UniMulti Histology (2 vs 1) 4.7 (2.2 -10.3)<0.00010.00044.6 (2.3 -9.4)<0.00010.0001 (3 vs 1)2.7 (0.96 -7.7)2.5 (1.0 -6.4) Age1.4 (1.1 – 1.7)0.02 1.3 (1.1 -1.6)0.01 Tumor Size 1.7 (1.1 – 2.7)0.040.031.3 (0.9 – 2.1)0.230.13

12. CTOS 2009 Conclusions Mastectomy for malignant phyllodes tumor and sarcomas of the breast achieves excellent local control. Wide local excision with breast conservation is feasible (+/- RT) with excellent local control in select patients Adjuvant radiotherapy should be considered when wide margins are not possible. Management of breast sarcoma should follow the same local control principles as for other sarcomas of the superficial tissues. Poor outcome of angiosarcomas warrants further research.

13. CTOS 2009 Acknowledgement Princess Margaret Hospital Cancer registry UHN Sarcoma group.

14. CTOS 2009 1991-2007 PMH Breast Cancer Report Visit YearThe number of Patients 19911123 19921277 19931351 19941260 19951334 19961486 19971578 19981652 19991419 20001038 20011062 2002968 20031263 20041423 20051167 20061335 20071375 Total22111

15. CTOS 2009