Access the full text.
Sign up today, get DeepDyve free for 14 days.
Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 2759650, 5 pages https://doi.org/10.1155/2019/2759650 Case Report Effective Treatment of a Malignant Breast Phyllodes Tumor with Doxorubicin-Ifosfamide Therapy 1 1 2 3 Shinya Yamamoto , Shigeru Yamagishi, Toshiro Kohno, Ryosuke Tajiri, 3 4 5 Toshikazu Gondo, Noboru Yoshimoto, and Nobuko Kusano Department of Breast Surgery, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa City, Kanagawa 251-8550, Japan Shonan Fujisawa Clinic, 1-15 Hanazawa-cho, Kugenuma, Fujisawa City, Kanagawa 251-0023, Japan Department of Diagnostic Pathology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa City, Kanagawa 251-8550, Japan Department of Thoracic Surgery, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa City, Kanagawa 251-8550, Japan Ambulatory Treatment Center, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa City, Kanagawa 251-8550, Japan Correspondence should be addressed to Shinya Yamamoto; firstname.lastname@example.org Received 11 February 2019; Revised 21 May 2019; Accepted 1 June 2019; Published 18 June 2019 Academic Editor: Katsuhiro Tanaka Copyright © 2019 Shinya Yamamoto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Malignant phyllodes tumors of the breast occur infrequently and are diﬃcult to treat with chemotherapy. Here, we present an eﬀective chemotherapy strategy for recurrent malignant breast phyllodes tumors. A 48-year-old woman was diagnosed with a malignant phyllodes tumor in her right breast and underwent total right mastectomy. One year later, the tumor recurred in the right (a 2.2 cm mass) and left (a 10 cm mass) lungs; pleural eﬀusion was also observed in the left lung. Eight courses of doxorubicin-ifosfamide (AI) therapy were administered. After treatment, the right lung mass and pleural eﬀusion regressed completely and the left lung mass regressed to 2 cm. In conclusion, AI therapy is useful for treating recurrent malignant breast phyllodes tumors. right lung (Figure 2(a)) and 10 cm mass and pleural eﬀusion 1. Introduction in the left lung (Figure 2(b)). The masses were diagnosed as Malignant phyllodes tumors of the breast are infrequent, recurrent malignant phyllodes tumors. They were deemed and eﬀective chemotherapy strategies are lacking. Here, we unresectable because they were present in both lungs, and describe an eﬀective treatment strategy for recurrent malig- pleural dissemination was suspected. nant breast phyllodes tumors. As an alternative treatment, we administered 8 courses of doxorubicin-ifosfamide (AI) therapy (30 mg/m doxorubicin on days 1-2 and 2 g/m ifosfamide on days 1-5) (Table 1). 2. Case Presentation After chemotherapy, the right lung mass regressed A 48-year-old woman presented to our hospital with a mass completely (Figure 3(a)), the left lung mass regressed to 2 cm (Figure 3(b)), and pleural eﬀusion was no longer in her right breast (Figure 1). A malignant phyllodes tumor was diagnosed via core needle biopsy, and right total mastec- detected. All 8 courses of AI therapy included mesna (sodium tomy was performed. The pathological ﬁndings were consis- 2-mercaptoethane sulfonate) and suﬃcient infusion volumes tent with the preoperative diagnosis, and the margins of the to prevent ifosfamide-related hemorrhagic cystitis. Hemor- resected tissue were negative. rhagic cystitis did not occur during any of the courses. Grade 4 neutropenia (as deﬁned by the Common Termi- One year later, the patient presented with cough and dys- pnea. Computed tomography revealed a 2.2 cm mass in the nology Criteria for Adverse Events (CTCAE)) occurred on 2 Case Reports in Oncological Medicine was refused by the patient. Thus, 4 courses of docetaxel (75 mg/m ) were administered instead. Although the right lung mass did not reappear (Figure 4(a)), the left lung mass increased in size to 5.5 cm (Figure 4(b)). As a result, the patient consented to surgery. Total left lung extraction and partial pericardial resection were performed. Pathological ﬁndings were consistent with a diagnosis of lung-metastatic breast phyllodes tumor, and curative resection was achieved (Figure 5). Four months after lung surgery, a 10 cm mass in the mediastinum (Figure 6(a)) and 6 cm mass in the left thoracic cavity (Figure 6(b)) were observed. The patient was therefore diagnosed with recurrent Figure 1: Computed tomography scan showing a 9-cm mass in the malignant phyllodes tumor of the left lung. One course of right breast (arrow). ifosfamide monotherapy (2 g/m on days 1-4) was adminis- tered. However, the patient’s condition worsened abruptly before discharge and she died. 3. Discussion Breast phyllodes tumors account for only 0.3%-0.9% of all breast tumors . Based on their histological features, they are classiﬁed as benign, boundary, or malignant; 13%-40% of malignant tumors show metachronous distant metastases. Owing to the low frequency of distant metastasis, only a (a) small number of retrospectively analyzed cases have been reported and a treatment strategy for malignant breast phyl- lodes tumors has not been established. Chemotherapy for unresectable distant metastases of malignant breast phyllodes tumors is generally similar to that used for soft tissue sarco- mas . The usefulness of anthracycline- and ifosfamide- based regimens [3, 4], as well as of high-capacity ifosfamide or anthracyclines plus granulocyte-macrophage colony- stimulating factor, for treatment of soft tissue sarcomas has been reported [5–7]. In accordance with previous reports [3–7], we administered AI therapy, using 60 mg/m doxorubicin and 10 g/m ifosfamide in each course. Because doxorubicin can be cardiotoxic, its total dose did not exceed (b) 500 mg/m . Regarding the dose indication of Adriamy- Figure 2: Computed tomography scan acquired before cin in our country, it is known that up to 500 mg is safe doxorubicin-ifosfamide (AI) chemotherapy showing (a) a 2.2 cm to administer. mass in the right lung (arrow) and (b) a 10 cm mass (arrow) and Leyvraz et al. administered a combination of high-dose pleural eﬀusion in the left lung (arrowheads). ifosfamide and high-dose doxorubicin to patients with soft tissue sarcomas , although at diﬀerent doses than those day 15 of the ﬁrst treatment cycle. To prevent the neutrope- used in our study. A total of 187 chemotherapy cycles were nia from advancing, ﬁlgrastim, a granulocyte colony- administered, and salvage therapy was also performed. The adverse events observed (and the percentage of cycles in stimulating factor, was administered on days 15 and 16 of the ﬁrst cycle and pegﬁlgrastim, a persistent granulocyte which they occurred) were as follows: grade 3 neutropenia colony-stimulating factor, was administered on day 8 or 9 (59%), febrile episodes (29%), grade 3 thrombocytopenia of the following cycle. Febrile neutropenia was not observed (39%), anemia (27%), and transient microscopic hematuria during any of the courses. (9%). One patient died of septic shock during the fourth We administered a diuretic drug at a concentration cycle. There were no instances of severe renal toxicity. appropriate for the patient’s weight when indicated, as well In our study, the right lung mass completely regressed as a selective neurokinin 1 (NK1) receptor antagonist or after 8 courses of AI therapy, and the left lung mass regressed other antiemetic. NK1 receptor antagonist administration considerably. Hence, AI therapy was very eﬀective. After AI was extended to 5 days owing to grade 2 nausea (as deﬁned therapy, we considered surgery (which the patient refused) by the CTCAE) after the second cycle, and good control of and ifosfamide single-agent therapy (which we ultimately the nausea was achieved. No other severe adverse events were rejected owing to slow tumor regression during the second noted. To avoid cardiotoxicity, AI therapy was terminated half of AI therapy). Instead, we opted to administer doce- after 8 courses. Surgery was considered at this point but taxel, the usefulness of which has been reported . The Case Reports in Oncological Medicine 3 Table 1: Doxorubicin-ifosfamide (AI) therapy regimen. Drug Volume/dose Infusion time Timing of administration Days 1-2 Saline 500 mL Rp. 1 SHC 20 mL 4 h Saline 100 mL Rp. 2 PH (day 1 only) 0.75 mg Dexamethasone 9.9 mg 15 min Saline 100 mL Rp. 3 Doxorubicin 30 mg/m 2h Saline 50 mL Rp. 4 Mesna 400 mL/m 15 min Saline 500 mL Rp. 5 Ifosfamide 2 g/m 4h Saline 500 mL Rp. 6 SHC 20 mL 4 h Saline 50 mL Rp. 7 Mesna 400 mL/m 15 min 4 h after Rp. 5 administration Saline 500 mL Rp. 8 SHC 20 mL 4 h Saline 50 mL Rp. 9 Mesna 400 mL/m 15 min 8 h after Rp. 5 administration Days 3-5 Saline 500 mL Rp. 1 SHC 20 mL 4 h Saline 100 mL Rp. 2 Dexamethasone 9.9 mg 15 min Saline 50 mL Rp. 3 Mesna 400 mL/m 15 min Saline 500 mL Rp. 4 Ifosfamide 2 g/m 4h Saline 500 mL Rp. 5 SHC 20 mL 4 h Saline 50 mL Rp. 6 Mesna 400 ml/m 15 min 4 h after Rp. 4 administration Saline 500 mL Rp. 7 SHC 20 mL 4 h Saline 50 mL Rp. 8 Mesna 400 mL/m 15 min 8 h after Rp. 4 administration Abbreviations: Rp: recipe; SHC: sodium hydrogen carbonate, 8.4%; PH: palonosetron hydrochloride; h: hour; min: minute; AI: doxorubicin-ifosfamide. approved docetaxel dose in Japan is 75 mg/m ; the dose completed smoothly and the patient was scheduled for dis- administered to our patient was 75 mg/m every 3 weeks. charge; however, her condition deteriorated suddenly, and Since eﬀective adjuvant chemotherapy after curative sur- she died soon thereafter. We believe that a cardiac or other gery has not been reported, it was not administered, and the important vessel ruptured during tumor regression; however, tumor in the left lung recurred 4 months after surgery. Selec- we were unable to conﬁrm this hypothesis because an tion of the subsequent chemotherapy drug was challenging. autopsy was not conducted. Although tumor regression was slow during the second half Mitus et al. reported that AI therapy was useful for treating of AI therapy, regression was observed; given the lack of breast phyllodes tumors; 1 patient in their study achieved a eﬀective chemotherapy regimens for this situation, ifosfa- complete response, and 2 patients achieved a partial response mide monotherapy was administered. The ﬁrst course was . A complete response was not obtained in our case. 4 Case Reports in Oncological Medicine (a) (b) Figure 3: Computed tomography scan acquired after doxorubicin-ifosfamide (AI) chemotherapy showing (a) complete regression of the right lung mass and (b) partial regression of the left lung mass to 2 cm (arrow) and an absence of pleural eﬀusion. (a) (b) Figure 4: Computed tomography scan acquired after docetaxel chemotherapy showing (a) a lack of reappearance of the right lung mass and (b) an increase in the size of the left lung mass to 5.5 cm (arrow). (a) Figure 5: Pathological examination after lung surgery showing a 9 cm mass in the left lung reaching just under and partially adjacent to the pleura. There was no direct inﬁltration of the upper or the lower pulmonary vein or the pericardium. Other possible treatments for a better prognosis included radiation therapy or the administration of another chemo- therapy regimen such as a combination of docetaxel and gemcitabine. A dose of 10 g/m of ifosfamide as a third therapy rather than 8 g/m in each cycle may also be con- sidered. Furthermore, it is arguable whether the option of (b) surgery is appropriate when the disease has progressed. Moreover, AI therapy has been successful, but further treat- Figure 6: Computed tomography scan acquired 4 months after lung ment is still controversial. surgery showing (a) a 10 cm mass in the mediastinum (arrow) and Given the low frequency with which malignant breast (b) a 6 cm mass in the left thoracic cavity (arrow). phyllodes tumors occur, distant metastasis, large-scale clini- cal trials are not feasible. Hence, case reports represent an Case Reports in Oncological Medicine 5  W. J. Köstler, T. Brodowicz, Y. Attems et al., “Docetaxel as res- important means by which to identify eﬀective treatments. cue medication in anthracycline- and ifosfamide-resistant Although AI therapy was not curative in our case, it resulted locally advanced or metastatic soft tissue sarcoma: results of in prominent tumor regression; therefore, this treatment a phase II trial,” Annals of Oncology, vol. 12, no. 9, pp. 1281– strategy may be considered for use in other cases. 1288, 2001.  J. W. Mitus, P. Blecharz, T. Walasek, M. Reinfuss, 4. Conclusion J. Jakubowicz, and J. Kulpa, “Treatment of patients with dis- tant metastases from phyllodes tumor of the breast,” World AI therapy is useful for treating recurrent malignant breast Journal of Surgery, vol. 40, no. 2, pp. 323–328, 2016. phyllodes tumors. Consent Informed consent for publication of this case report and any accompanying images was obtained using the opt-out system. Conflicts of Interest The authors declare that there are no conﬂicts of interest regarding the publication of this article. References  E. Y. Tan, T. P. Hoon, W. S. Yong et al., “Recurrent phyllodes tumours of the breast: pathological features and clinical impli- cations,” ANZ Journal of Surgery, vol. 76, no. 6, pp. 476–480,  C. Confavreux, A. Lurkin, N. Mitton et al., “Sarcomas and malignant phyllodes tumours of the breast – a retrospective study,” European Journal of Cancer, vol. 42, no. 16, pp. 2715–2721, 2006.  P. Casali, U. Pastorino, A. Azzarelli et al., “Perspectives on anthracyclines plus ifosfamide in advanced soft tissue sar- comas,” Cancer Chemotherapy and Pharmacology, vol. 31, Supplement 2, pp. S228–S232, 1993.  S. Frustaci, F. Gherlinzoni, A. de Paoli et al., “Adjuvant chemo- therapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial,” Journal of Clinical Oncology, vol. 19, no. 5, pp. 1238–1247,  A. Le Cesne, I. Judson, D. Crowther et al., “Randomized phase III study comparing conventional-dose doxorubicin plus ifosfamide versus high-dose doxorubicin plus ifosfamide plus recombinant human granulocyte-macrophage colony- stimulating factor in advanced soft tissue sarcomas: a trial of the European Organization for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group,” Journal of Clinical Oncology, vol. 18, no. 14, pp. 2676–2684, 2000.  S. Leyvraz, M. Bacchi, T. Cerny et al., “Phase I multicenter study of combined high-dose ifosfamide and doxorubicin in the treatment of advanced sarcomas,” Annals of Oncology, vol. 9, no. 8, pp. 877–884, 1998.  H. J. Weh, M. Zügel, D. Wingberg et al., “Chemotherapy of metastatic soft tissue sarcoma with a combination of adriamy- cin and DTIC or adriamycin and ifosfamide,” Oncology Research and Treatment, vol. 13, no. 6, pp. 448–452, 1990.  S. Leyvraz, R. Herrmann, L. Guillou et al., “Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage ther- apies,” British Journal of Cancer, vol. 95, no. 10, pp. 1342– 1347, 2006. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018
Case Reports in Oncological Medicine – Hindawi Publishing Corporation
Published: Jun 18, 2019
Access the full text.
Sign up today, get DeepDyve free for 14 days.