ADVANCES IN THE THERAPEUTIC UNDERSTANDING OF BREAST PHYLLODES TUMOR

Abstract

Phyllodes tumor of the breast is a rare fibroepithelial neoplasm, accounting for approximately 0.3% to 1% of all breast cancers. It presents variable biological behavior and can be classified as benign, borderline, or malignant, according to the histological criteria of the World Health Organization. Although surgery is the standard treatment, the management of borderline and malignant subtypes remains controversial, especially regarding the role of adjuvant therapies. This paper aims to gather and discuss the most recent evidence on the treatment of phyllodes tumor of the breast, emphasizing advances in surgical approaches, the use of radiotherapy, chemotherapy, and the emergence of targeted therapies and immunotherapies. A narrative literature review was conducted, searching for articles published between 2015 and 2025 in the PubMed and BVS databases, using the descriptors "phyllodes tumor" and "therapy." Surgery with free margins remains the main prognostic factor and the mainstay of treatment. Adjuvant radiotherapy has shown benefits in locoregional control, especially in malignant or recurrent tumors, although it has no clear impact on overall survival. Chemotherapy has shown limited and controversial results and is indicated only in selected cases. Advances in molecular biology have identified genetic alterations, such as mutations in MED12, EGFR, PDGFRA, and p53, which open up prospects for targeted therapies and experimental immunotherapies, representing a new frontier in individualized management. The treatment of breast phyllodes tumor still lacks standardization in the most aggressive subtypes. Surgery remains the mainstay of therapy, but a deeper understanding of the disease's molecular structure may, in the near future, enable personalized therapeutic strategies with the potential to improve prognosis and reduce recurrences.