1
|
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. Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland. Clin Oncol (R Coll Radiol) 2024; 36:e31-e39. [PMID: 38294995 DOI: 10.1016/j.clon.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 02/02/2024]
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.
Collapse
Affiliation(s)
- M K Bishr
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - J Banks
- The Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - M S Abdelaziz
- National Cancer Institute, Cairo University, Cairo, Egypt; University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Badawi
- East Sussex Healthcare Trust, Conquest Hospital, St Leonards-on-sea, UK
| | - P W Crane
- Queen Elizabeth II Hospital, Welwyn Garden City, UK
| | | | - M Elkorety
- West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - M Girgis
- West Suffolk NHS Hospital, Bury St Edmunds, UK
| | - A Humphreys
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - J Isherwood
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - J Kahan
- Velindre Cancer Centre, Cardiff, UK
| | - S Keelan
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - E K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - I Nixon
- Management Science, Business School, Strathclyde University, Glasgow, UK; The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Sackey
- Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - H Soliman
- Kings' College Hospital, Orpington, UK
| | - N Touqan
- Manchester University NHS Foundation Trust, North Manchester General Hospital, Manchester, UK
| | - D D Remoundos
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Scott NP, Teoh EJ, Flight H, Jones BE, Niederer J, Mustata L, MacLean GM, Roy PG, Remoundos DD, Snell C, Liu C, Gleeson FV, Harris AL, Lord SR, McGowan DR. Characterising 18F-fluciclovine uptake in breast cancer through the use of dynamic PET/CT imaging. Br J Cancer 2022; 126:598-605. [PMID: 34795409 PMCID: PMC8854436 DOI: 10.1038/s41416-021-01623-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND 18F-fluciclovine is a synthetic amino acid positron emission tomography (PET) radiotracer that is approved for use in prostate cancer. In this clinical study, we characterised the kinetic model best describing the uptake of 18F-fluciclovine in breast cancer and assessed differences in tracer kinetics and static parameters for different breast cancer receptor subtypes and tumour grades. METHODS Thirty-nine patients with pathologically proven breast cancer underwent 20-min dynamic PET/computed tomography imaging following the administration of 18F-fluciclovine. Uptake into primary breast tumours was evaluated using one- and two-tissue reversible compartmental kinetic models and static parameters. RESULTS A reversible one-tissue compartment model was shown to best describe tracer uptake in breast cancer. No significant differences were seen in kinetic or static parameters for different tumour receptor subtypes or grades. Kinetic and static parameters showed a good correlation. CONCLUSIONS 18F-fluciclovine has potential in the imaging of primary breast cancer, but kinetic analysis may not have additional value over static measures of tracer uptake. CLINICAL TRIAL REGISTRATION NCT03036943.
Collapse
Affiliation(s)
- N P Scott
- Department of Oncology, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E J Teoh
- Department of Oncology, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Blue Earth Diagnostics Ltd, Oxford Science Park, Oxford, UK
| | - H Flight
- Department of Oncology, University of Oxford, Oxford, UK
| | - B E Jones
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - J Niederer
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - L Mustata
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G M MacLean
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - P G Roy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D D Remoundos
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Snell
- Mater Research, University of Queensland, Brisbane, QLD, Australia
- Mater Pathology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - C Liu
- Mater Pathology, Mater Hospital Brisbane, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - F V Gleeson
- Department of Oncology, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A L Harris
- Department of Oncology, University of Oxford, Oxford, UK
- MRC Weatherall Institute of Molecular Medicine, Oxford, UK
| | - S R Lord
- Department of Oncology, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D R McGowan
- Department of Oncology, University of Oxford, Oxford, UK.
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| |
Collapse
|
3
|
Thind A, Patel B, Thind K, Isherwood J, Phillips B, Dhaliwal K, Remoundos DD. Surgical margins for borderline and malignant phyllodes tumours. Ann R Coll Surg Engl 2020; 102:165-173. [PMID: 31918563 DOI: 10.1308/rcsann.2019.0140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins. METHODS MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale. RESULTS Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm. CONCLUSION Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.
Collapse
Affiliation(s)
- A Thind
- Croydon University Hospital, Croydon Health Services NHS Trust, Thornton Heath, UK
| | - B Patel
- Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - K Thind
- King's College Hospital NHS Foundation Trust, London, UK
| | - J Isherwood
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - B Phillips
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Dhaliwal
- University of Western Ontario, London, Ontario, Canada
| | | |
Collapse
|