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

Mai K. Bishr; Jenny Banks; Mohamed S. Abdelaziz; Marwa Badawi; Peter W. Crane; Urszula Joanna Donigiewicz; Mohamed Elkorety; Mina Girgis; Alex Humphreys; Jen Isherwood; Jennifer Kahan; Stephen Keelan; Ebba K. Lindqvist; Ioanna Nixon; Helena Sackey; Carl Sars; Hesham Soliman; Nader Touqan; Dionysios Dennis Remoundos; Mahbubl Ahmed

doi:10.1016/j.clon.2023.10.050

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

Mai K. Bishr^*
, Jenny Banks
, Mohamed S. Abdelaziz
, Marwa Badawi
, Peter W. Crane
, Urszula Joanna Donigiewicz
, Mohamed Elkorety
, Mina Girgis
, Alex Humphreys
, Jen Isherwood
, Jennifer Kahan
, Stephen Keelan
, Ebba K. Lindqvist
, Ioanna Nixon
, Helena Sackey
, Carl Sars
, Hesham Soliman
, Nader Touqan
, Dionysios Dennis Remoundos
, Mahbubl Ahmed

^*Corresponding author for this work

Management Science

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Pages (from-to)	e31-e39
Number of pages	19
Journal	Clinical Oncology
Volume	36
Issue number	1
Early online date	21 Oct 2023
DOIs	https://doi.org/10.1016/j.clon.2023.10.050
Publication status	Published - 31 Jan 2024

Funding

Mai K. Bishr ( NIHR Academic Clinical Fellowship award, Institute of Cancer Research UK, ACF-2022-22-002) is funded by Health Education England (HEE)/ NIHR for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, Institute of Cancer Research UK, NHS or the UK Department of Health and Social Care. The funding source had no involvement in any aspect of this study design, data collection, analysis or interpretation. Figures were created with BioRender. In non-radiation-induced breast angiosarcoma, also known as primary breast angiosarcoma, there is evidence from retrospective studies and meta-analysis that adjuvant radiotherapy improves local control, but not survival outcomes [35–37]. Similar local control outcomes were reported for STS of the breast [38,39], with evidence supporting improved survival with adjuvant radiotherapy for tumours >5 cm [40]. Among the participating MDTs in this study, up to 25% recommended adjuvant radiotherapy for angiosarcoma and up to 29% for STS.Mai K. Bishr (NIHR Academic Clinical Fellowship award, Institute of Cancer Research UK, ACF-2022-22-002) is funded by Health Education England (HEE)/NIHR for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, Institute of Cancer Research UK, NHS or the UK Department of Health and Social Care. The funding source had no involvement in any aspect of this study design, data collection, analysis or interpretation. Figures were created with BioRender.

Keywords

angiosarcoma
breast sarcoma
management
phyllodes
radiotherapy
surgical margin

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10.1016/j.clon.2023.10.050

Bishr-etal-CO-2023-Multidisciplinary-management-of-phyllodes-tumours-and-breast-sarcomaAccepted author manuscript, 8.05 MBLicence: CC BY-NC-ND 4.0

Cite this

Bishr, M. K., Banks, J., Abdelaziz, M. S., Badawi, M., Crane, P. W., Donigiewicz, U. J., Elkorety, M., Girgis, M., Humphreys, A., Isherwood, J., Kahan, J., Keelan, S., Lindqvist, E. K., Nixon, I., Sackey, H., Sars, C., Soliman, H., Touqan, N., Remoundos, D. D., & Ahmed, M. (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. 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 {\textquoteleft}no tumour on ink{\textquoteright} 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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author = "Bishr, \{Mai K.\} and Jenny Banks and Abdelaziz, \{Mohamed S.\} and Marwa Badawi and Crane, \{Peter W.\} and Donigiewicz, \{Urszula Joanna\} and Mohamed Elkorety and Mina Girgis and Alex Humphreys and Jen Isherwood and Jennifer Kahan and Stephen Keelan and Lindqvist, \{Ebba K.\} and Ioanna Nixon and Helena Sackey and Carl Sars and Hesham Soliman and Nader Touqan and Remoundos, \{Dionysios Dennis\} and Mahbubl Ahmed",

year = "2024",

month = jan,

day = "31",

doi = "10.1016/j.clon.2023.10.050",

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pages = "e31--e39",

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Bishr, MK, Banks, J, Abdelaziz, MS, Badawi, M, Crane, PW, Donigiewicz, UJ, Elkorety, M, Girgis, M, Humphreys, A, Isherwood, J, Kahan, J, Keelan, S, Lindqvist, EK, Nixon, I, Sackey, H, Sars, C, Soliman, H, Touqan, N, Remoundos, DD & Ahmed, M 2024, 'Multidisciplinary management of phyllodes tumours and breast sarcoma: a cross-sectional survey of clinical practice across the United Kingdom and Ireland', Clinical Oncology, vol. 36, no. 1, pp. e31-e39. https://doi.org/10.1016/j.clon.2023.10.050

TY - JOUR

T1 - Multidisciplinary management of phyllodes tumours and breast sarcoma

T2 - a cross-sectional survey of clinical practice across the United Kingdom and Ireland

AU - Bishr, Mai K.

AU - Banks, Jenny

AU - Abdelaziz, Mohamed S.

AU - Badawi, Marwa

AU - Crane, Peter W.

AU - Donigiewicz, Urszula Joanna

AU - Elkorety, Mohamed

AU - Girgis, Mina

AU - Humphreys, Alex

AU - Isherwood, Jen

AU - Kahan, Jennifer

AU - Keelan, Stephen

AU - Lindqvist, Ebba K.

AU - Nixon, Ioanna

AU - Sackey, Helena

AU - Sars, Carl

AU - Soliman, Hesham

AU - Touqan, Nader

AU - Remoundos, Dionysios Dennis

AU - Ahmed, Mahbubl

PY - 2024/1/31

Y1 - 2024/1/31

N2 - 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.

AB - 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.

KW - angiosarcoma

KW - breast sarcoma

KW - management

KW - phyllodes

KW - radiotherapy

KW - surgical margin

U2 - 10.1016/j.clon.2023.10.050

DO - 10.1016/j.clon.2023.10.050

M3 - Article

SN - 0936-6555

VL - 36

SP - e31-e39

JO - Clinical Oncology

JF - Clinical Oncology

IS - 1

ER -

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

Abstract

Funding

Keywords

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