Challenges in Management of Malignant Phyllodes Tumor with Thoracic Wall Infiltration a Retrospective Case Series

Malignant phyllodes tumors are rare fibroepithelial breast neoplasms with aggressive behavior, particularly when they infiltrate the thoracic wall, where achieving adequate surgical margins and timely adjuvant treatment becomes difficult. This study aimed to describe the clinical management and outcomes of patients with malignant phyllodes tumors involving the thoracic wall, focusing on surgical margin status, local recurrence, adjuvant radiotherapy, and overall clinical outcome. A retrospective descriptive case-series design was used by reviewing medical records of three patients treated at the Oncology Surgery Department, Padjadjaran University–RS Hasan Sadikin. Data included patient characteristics, surgical treatment, histopathological margin status, timing of radiotherapy, recurrence, metastasis, and clinical outcomes, which were analyzed descriptively. All patients underwent wide local excision. Only one patient achieved a tumor-free margin and remained free from local recurrence while receiving adjuvant radiotherapy, although pleural effusion suspicious for metastasis developed. The other two patients had positive margins, experienced rapid local recurrence within two to four weeks after surgery, and died before radiotherapy could be administered. These findings indicate that achieving negative surgical margins is crucial for local control, while prompt adjuvant treatment and continued systemic surveillance remain important in managing this rare and aggressive disease, especially in patients with extensive thoracic wall involvement.