The impact of Adjuvant radiotherapy on Borderline and Malignant Phyllodes Tumors of The Breast

The impact of Adjuvant radiotherapy on Borderline and Malignant Phyllodes Tumors of The Breast | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The impact of Adjuvant radiotherapy on Borderline and Malignant Phyllodes Tumors of The Breast Amonthep Charoenyothakun, Kanjana Shotelersuk, Chonnipa Nantavithya, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5774733/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 May, 2025 Read the published version in Breast Cancer → Version 1 posted 5 You are reading this latest preprint version Abstract Background: Borderline and malignant phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast and have a high local recurrence rate (LRR). The use of adjuvant radiation therapy (RT) for local control has increased in recent decades, but its impact on outcomes remains uncertain. We aim to assess the efficacy of radiotherapy and define the factors that are associated with local recurrence. Material and Methods : The study provides a retrospective review of all patients with borderline and malignant phyllodes tumors of the breast who underwent surgery between 2012 and 2021 at our institute. Medical records were examined for clinical data, tumor characteristics, treatment factors, and follow-up status. The primary endpoint was LRR. Kaplan-Meier and Cox regression models were conducted to determine LRRs and the risk factors correlated with an increased risk of LR. Results: The median follow-up was 4.3 years. A total of 102 patients were analyzed: 50 with borderline and 52 with malignant PTs. Patients who are in the malignant group tend to have a larger tumor size (larger than 10 cm) (63.5% vs. 22% of the borderline, p<0.001). The majority of patients with malignant PT underwent mastectomy (TM) (75% vs. 11% of borderline, p<0.001) and had adjuvant RT (78.9% vs. 8% of borderline, p<0.001). There were two borderline patients who had LR, which occurred after 5 years of follow-up. For malignant PTs, all of those recurred before the 5-year follow-up period. Among patients who did not have adjuvant RT, those with malignant PTs experienced a significantly greater rate of LR compared to those with borderline PTs (36.4% vs. 4.4%, p < 0.010). In patients with malignant subtypes, adjuvant RT was associated with a lower local recurrence rate however, the difference was not statistically significant (12.2% vs. 36.4% without RT, p=0.081). The 5-year LRRs of patients with malignant PTs who underwent breast-conserving surgery (BCS), BCS with RT, TM, and TM with RT were 33.3%, 20%, 37.5%, and 9.1%, respectively (p=0.286). In multivariate analysis, the subtype of the tumor (borderline vs. malignant) was the only risk factor that was associated with LR in all patients (p=0.011). Age, tumor size, type of surgery, receiving adjuvant RT, and resection margin were not shown to be correlated with LR in patients with malignant subtypes. For patients who have malignant PTs and underwent adjuvant RT, the timing of RT after surgery (later than 12 weeks) was the only risk factor associated with LR (p=0.009). The use of different radiation techniques (3D vs. intensity modulated radiation therapy), radiation doses (50–60 Gy vs. 60–66 Gy), or the application of a bolus did not show an evident association with LR in this group of patients. Conclusion: This is to confirm that patients with malignant PTs had a higher LRR compared to borderline PTs. In our study, a statistically significant benefit of adjuvant RT was not observed in either borderline or malignant PTs. However, there was a trend toward the efficacy of adjuvant RT in reducing the incidence of LR in cases of malignant PTs. Figures Figure 1 Figure 2 Introduction Phyllodes tumors (PTs) are rare fibroepithelial lesions that account for 0.3–1% of breast neoplasms. They are distinguished by enhanced stromal proliferation and "leaf-like" tumor cell growth patterns. The World Health Organization (WHO) guideline classifies PTs into benign, borderline, and malignant subtypes based on histopathologic characteristics [1, 2]. The malignant PTs account for 20% of all PTs and have a higher tendency to behave aggressively and metastasis [3]. Breast-conserving surgery (BCS) or total mastectomy (TM) with surgical margins of ≥ 1 cm are the mainstays of the curative treatment of PTs [4, 5]. According to recent reports of borderline and malignant PTs, the local recurrence rate (LRR) within 2 years after surgery is 21% and 36%, and distant metastases (DM) are 25% and 40%, respectively [5, 6]. The most common sites of metastasis are the lungs (66%), bone (28%), and brain (9%). Despite the generally favorable prognosis of PTs, the 5-year cancer-specific survival rates vary by subtype, ranging from approximately 80–92% for borderline and malignant PTs, with malignant subtypes exhibiting a higher risk of recurrence and metastasis.[7, 8]. Due to the high LR rates observed in borderline and malignant PTs, adjuvant RT has been increasingly used to enhance local control. While surgery remains the primary treatment, the role of RT in reducing recurrence risk has been explored in several studies, with varying conclusions. Barth et al.'s study, the only prospective study to date, reports excellent local control (LC) for borderline and malignant PTs treated with margin-negative BCS and adjuvant RT [5]. Gnerlich et al., an analysis of cases collected from NCDB from 1998–2009, adjuvant RT increased time to LR and a significant decrease in LR in women who received adjuvant RT versus surgery alone for malignant PTs but without a significant improvement in disease-free survival (DFS) or overall survival (OS) [7]. Belkacemi et al., demonstrated that adjuvant RT resulted in a higher 10-year LC rate for borderline and malignant PTs (86% with radiation versus 59% without radiation) [6]. Several retrospective studies have shown an improvement in LC; however, results are inconclusive and the indications for adjuvant local therapies remain debatable. Due to the rarity of the disease entity and especially the small numbers of borderline and malignant subtypes that received adjuvant RT, there were no randomized clinical trials and no studies involving the radiation technique. This study aims to assess the efficacy of radiotherapy in patients with borderline and malignant PTs, identify factors associated with increased risk of LR, define subgroups of patients that may potentially benefit from adjuvant RT, and collect data involving the radiation technique. Material and Methods The study provides a retrospective review of all patients with borderline and malignant PTs of the breast who underwent surgery (BCS or TM) between 2012 and 2021 at our institute. Patients were excluded if they had: (1) recurrent phyllodes tumors or distant metastasis at diagnosis, (2) a history of other malignancies before or after PTs diagnosis, (3) a follow-up duration of less than two years, (4) prior radiation therapy to the breast, or (5) incomplete medical records preventing full data analysis. After IRB approval (IRB No. 0061/66), the medical records were examined for clinical data, tumor characteristics, treatment factors, and follow-up status. The primary endpoint was LRR. Kaplan-Meier and Cox regression models were conducted to determine LRR and the risk factors correlated with an increased risk of LR. A P-value < 0.05 was considered statistically significant Results Patient Characteristics The median follow-up was 4.3 years. 102 patients were analyzed; 50 patients had borderline, and 52 patients had malignant PTs. Key variables examined included age at diagnosis, tumor size, surgical interventions, margin status, adjuvant RT, radiation techniques, dosage, fractionation, and radiation timing after surgery, as well as follow-up duration. The median age at diagnosis was similar across groups: total populations (48 years), borderline (46 years), and malignant (49 years), with no statistically significant difference (P = 0.053). The median tumor size was significantly larger in the malignant group (12 cm) compared to the borderline group (5.6 cm), with a P-value of <0.001. Tumor size 15 cm was predominantly in the malignant group (34.6%). BCS was more common in the borderline group (78%), while TM was more frequent in the malignant group (75%); this difference was statistically significant (P < 0.001). Most patients had margins ≥ 1 cm (total: 80.4%); no significant difference was observed in margin status across the groups (P = 0.300). Adjuvant radiation was administered to 78.9% of patients in the malignant group compared to 8% in the borderline group, with a P-value of <0.001, a significant difference. Radiation technique (3D vs. IMRT/VMAT), total radiation dose, and fractionation were not significantly different between groups. The median timing for radiation after surgery was slightly longer for the borderline group but not significantly different (P = 0.130). Median follow-up duration was significantly longer in the borderline group (5.0 years) compared to the malignant group (3.7 years), with a P-value of 0.046. Details in Table 1 Table 1 . Characteristics of patient Total(N=102) Borderline(N=50) Malignant(N=52) P-value Age (years) at diagnosis, Median (IQR) 48 (40-55) 46 (37-53) 49 (42.5-58) 0.053 Tumor size (cm) , Median (IQR) 8 (4.8-14.1) 5.6 (4.1-8.8) 12 (6.6-17.5) <0.001 Tumor size (cm), n (%) <0.001 15 21 (20.6) 3 (6) 18 (34.6) Surgery, n (%) <0.001 BCS 52 (51) 39 (78) 13 (25) TM 50 (49.0) 11 (22) 39 (75) Margin, n (%) 0.300 ≥ 1 cm 82 (80.4) 40 (80) 42 (80.8) < 1 cm 15 (14.7) 9 (18) 6 (11.5) Positive 5 (4.9) 1 (2) 4 (7.7) Adjuvant radiation, n (%) 45 (44.1) 4 (8) 41 (78.9) <0.001 Radiation Technique, n (%) 0.233 3D 34 (75.6) 4 (100) 30 (73.2) IMRT/VMAT 11 (24.4) 0 (0) 11 (26.8) Total dose (Gy) , median (IQR) 60 (51-60) 55 (50-60) 60 (51-60) 0.289 Total dose (Gy), n(%) 0.560 50-59 13 (28.9) 2 (50) 11 (26.8) 60-66 32 (71.1) 2 (50) 30 (73.2) Bolus (Fx), n (%) 0.800 0 24 (53.3) 3 (75) 21 (51.2) 1-10 12 (26.7) 1 (25) 11 (26.8) >10 9 (20) 0 9 (22.0) Dose/Fx (Gy/Fx ), n (%) 0.650 2 43 (95.6) 4 (100) 39 (95.1) 3 2 (4.4) 0 (0) 2 (4.9) Radiation timing after surgery (Wk) median ( IQR) 8 (4-8) 10 (8-14) 8 (4-8) 0.130 Year of follow-up, median (IQR) 4.3 (2.5-5.8) 5.0 (2.7-6.5) 3.7 (2.3-5.3) 0.046 Abbreviations: BCS= breast conserving surgery, TM= total mastectomy, 3D= Three dimension conformal Radiotherapy , IMRT/VMAT= Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy, Fx = Fractions Clinical outcomes There was no significant difference in LR between different surgery types, with P-values of 0.443 for borderline cases and 0.674 for malignant cases. Regarding the margin status, patients with a margin less than 1 cm and a positive margin had a significantly higher LR in malignant patients (P = 0.044). Adjuvant RT does not result in a difference in LR for either borderline or malignant patients. However, there has been a trend toward a reduction in the number of recurrence cases when adding radiotherapy to malignant cases (12.2% vs. 36.4% without RT, P = 0.081). There were no significant differences in recurrence rates between RT technique, total dose, bolus administration, and dose per fraction (Gy/Fx). Details in Table 2 Table 2 Proportion of local recurrence rate by groups Total(N=102) Borderline (N=50) Malignant(N=52) Overall 11 (10.8) 2 (4) 9 (17.3) Surgery, n (%) BCS 5/52 (9.6) 2/39 (5.1) 3/13 (23.1) TM 6/50 (12) 0/11 (0) 6/39 (15.4) P-value 0.598 0.443 0.674 Margin, n (%) - > 1 cm 7/82 (8.5) 2/40 (5) 5/42 (11.9) - < 1 cm 3/15 (20) 0/9 (9.1) 3/6 (50) - Positive P-value 1/5 (10) 0.263 0/1 (0) 0.576 1/4(25) 0.044 Treatment modality, n (%) BCS 3/40 (7.5) 2/37 (5.4) 1/3 (33.3) BCS+RT 2/12 (16.7) 0/2 (0) 2/10 (20) P-value 0.325 0.736 0.631 TM 3/17 (17.7) 0/9 (0) 3/8 (37.5) TM+RT 3/33 (9.1) 0/2 (0) 3/31 (9.7) P-value 0.396 NA 0.088 Adjuvant radiation, n (%) No 6/57 (10.5) 2/46 (4.4) 4/11 (36.4) Yes 5/45 (11.1) 0/4 (0) 5/41 (12.2) P-value 0.925 0.670 0.081 Radiation Technique, n (%) 3D 2/34 (5.9) 0/4 (0) 2/30 (6.7) IMRT/VMAT 3/11 (27.3) - 3/11 (27.3) P-value 0.085 NA 0.110 Total dose (Gy), n(%) 50-59 1/13 (7.7) 0/2 (0) 1/11 (9.1) 60-66 4/32 (12.5) 0/2 (0) 4/30 (13.3) P-value 0.642 NA 0.713 Bolus (Fx), n (%) 0 2/24 (8.3) 0/3 (0) 2/21 (9.5) 1-10 2/12 (16.7) 0/1 (0) 2/11 (18.2) >10 1/9 (11.1) - 1/9 (11.1) P-value 0.821 NA 0.824 Dose/Fx (Gy/Fx ) , n (%) 2 5/43 (11.6) 0/4 (0) 5/39 (12.8) 3 0/2 (0) - 0/2 (0) P-value 0.609 NA 0.589 Abbreviations: BCS= breast conserving surgery, TM= total mastectomy, RT = Adjuvant radiation therapy, 3D= Three dimension conformal Radiotherapy , IMRT/VMAT= Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy, Fx = Fractions For patients with borderline and malignant PTs, the 5-year local recurrence-free survival rate (LRFS) after surgery was 100% and 81.7%, respectively. There was a statistically significant difference in LRFS after surgery between borderline and malignant patients (P = 0.010). (Fig 1) There was no statistically significant difference for 5-year LRFS after complete treatment (either surgery alone or surgery with RT) for all groups (BCS, BCS+RT, TM, and TM+RT were 97.5%, 83.3%, 81.5%, and 90.9%, respectively, P = 0.508). (Fig 1S) The 5-year LRFS for malignant patients was 66.7% with BCS alone, 80% with BCS+RT, 62.5% with TM alone, and 90.3% with TM+RT, with no statistically significant differences between these groups. (P= 0.286) (Fig 2) Prognostic factors Our analysis revealed a significant association between tumor subtype and the risk of LR. Malignant PTs were associated with a much higher risk of LR compared to borderline PTs, with a hazard ratio (HR) of 5.7 (95% CI 1.22-27.36, P=0.027) in the univariate analysis and an adjusted HR of 12.85 (95% CI 1.81-91.07, P=0.011) in the multivariate analysis. Age at diagnosis did not significantly affect risk of LR, with patients over 50 showing no increased risk compared to those 50 or younger (HR 1.54, 95% CI 0.40-5.89, P=0.525). Positive margins showed a trend toward higher recurrence, though this was not statistically significant. In terms of other factors, tumor size, surgery type (BCS vs. TM), and adjuvant RT did not demonstrate significant associations with the risk of LR in either univariate or multivariate analysis. The timing of adjuvant RT is significantly associated with LR for malignant PT patients. Delaying RT beyond 12 weeks post-surgery resulted in a higher recurrence rate, with a hazard ratio (HR) of 18.9 (95% CI 2.09-170.6, P = 0.009) in the univariate analysis and an adjusted HR of 18.19 (95% CI 12.01-165 , P=0.010) in the multivariate analysis. RT technique, total dose, and bolus administration did not significantly influence local recurrence rates in our analysis. These findings are summarized in Tables 3, 1S, and 2S. Table 3 Risk factor associated with LR for malignant patient who received RT after surgery (N = 41) Univariate Multivariate HR (95% CI) P-value aHR (95% CI) P-value Age at diagnosis ≤ 50 3.44 (0.38-30.81) 0.269 > 50 1 Tumor size (cm), group < 10 1 ≥ 10 0.65 (0.11-3.89) 0.637 Surgery BCS 1 - TM 0.42 (0.07-2.53) 0.346 Margin Negative 1 Positive 1.17 (0.22-6.296) 0.425 RT Technique 3D 1 1 IMRT/VMAT 4.35 (0.72-26.1) 0.107 4.01(0.66-24.21) 0.131 Total dose (Gy),n(%) 50-59 1 60-66 1.76 (0.20-15.78) 0.612 Bolus (Fx) 0 1 >=1 1.57 (0.26-9.44) 0.617 Radiation timing after surgery < 12 weeks 1 1 ≥ 12 weeks 18.9 (2.09-170.6) 0.009 18.19 (12.01-165) 0.010 Univariate and multivariate were evaluated with Cox regression model. Multivariate were developed by covariate with P< 0.2 from univariate. Abbreviations :HR = Hazard ratio, aHR = adjusted Hazard ratio, BCS= breast conserving surgery, TM= total mastectomy, RT = Adjuvant radiation therapy, 3D= Three dimension conformal Radiotherapy , IMRT/VMAT= Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy, Fx = Fractions Discussion This retrospective analysis included a cohort of 102 patients, consisting of 50 with borderline PTs and 52 with malignant PTs, with a median follow-up duration of 4.3 years. Our patients’ characteristics were largely consistent with those reported in other studies, particularly the younger age group. The median tumor size in our study was larger than in other retrospective studies.[10, 11], which median tumor sizes typically ranged from between 5 and 7.2 cm. Also, the proportion of malignant PTs (greater than 10 cm) was significantly higher compared to borderline PTs. This larger tumor size is associated with more aggressive surgical approaches, with a higher likelihood of TM for malignant cases. In our study, the majority of patients with malignant PTs underwent TM, compared to a much smaller proportion of borderline PT cases (75% vs. 11%, p < 0.001). In our study, the 5-year LRFS rates were 100% for borderline phyllodes tumors (PTs) and 81.7% for malignant PTs. These rates are comparable to, and in some cases better than, those reported in other studies. For instance, Gnerlich et al. [7] reported 5-year LRFS rates of 94% for borderline PTs and approximately 75% for malignant PTs, indicating slightly lower rates for both groups compared to our findings. The LRR in our study was lower than those reported in other studies, with 4% for borderline and 17.3% for malignant PTs. According to the WHO 2012 classification, LR can occur in any PT subtype, with an overall prevalence of 21%. The reported recurrence rates vary from 10-17% for benign PTs, 14-25% for borderline PTs, and 23-30% for malignant PTs [6, 11, 14]. One possible explanation for the lower LRR in our study is the high rate of wide resection margins , with over 80% of cases having a margin greater than 1 cm. Although margin width was not a significant factor for LRR in our study, our results did show that close or positive surgical margins were associated with a higher LRR in malignant PTs. Other studies, such as those by Barrio et al. [12] and Tremblay-LeMay et al. [15], have identified margin status as a key factor influencing local recurrence. Several studies have shown the efficacy of adjuvant RT in reducing LRR in malignant PTs. For example, Barth et al. [5], the only prospective study to date, report excellent LC for malignant PTs treated with margin-negative BCS and adjuvant RT, and a retrospective analysis by Gnerlich et al. [7] demonstrated that adjuvant RT significantly decreased LRR in patients with malignant PTs. In our study, we observed a trend toward lower local recurrence rates (LRR) in malignant PT patients who received adjuvant RT compared to those who did not (12.2% vs. 36.4%, p = 0.081), suggesting a potential benefit in selected high-risk cases. This result is consistent with other studies [5, 6, 7] and indicates the efficacy of adjuvant RT in reducing LRR, particularly in malignant PTs. The timing of adjuvant RT administration post-surgery was a significant factor influencing LR risk in patients with malignant PTs in our study. Patients who received RT more than 12 weeks after surgery had a significantly higher LRR compared to those who received it earlier. To our knowledge, our study is one of the few to report on RT timing in phyllodes tumors as a potential factor influencing local control, emphasizing the importance of early initiation. Other factors, such as patient age, tumor size, type of surgery, resection margin, and radiation technique or dose, did not demonstrate significant associations with LR risk in patients with borderline and malignant PTs. These findings are consistent with, but also differ in some respects from, other studies: Patient age, Macdonald et al. [8] similarly reported that age was not a significant predictor of recurrence in malignant PTs. However, some studies, such as Chaney et al. [16], suggested that younger age might be associated with higher recurrence rates, possibly due to biological differences in tumor behavior. Tumor size, Kapiris et al. [17] reported that tumor size has an effect on LC and survival in patients with malignant subtypes of PT, with a significantly increased risk for tumors larger than 10 cm. Type of Surgery and Resection Margin, Barrio et al. [12] also concluded that the choice of surgery (lumpectomy or mastectomy) is less critical than achieving negative surgical margins. NCCN [4] and The WHO classification [14] emphasizes the importance of achieving negative margins to reduce recurrence rates. Regarding RT technique and dose, our study found no significant differences in LRR between 3D and IMRT/VMAT, or between radiation doses, which is consistent with previous findings by Belkacemi et al. [6] and Gnerlich et al. [7]. This suggests that the effectiveness of RT may depend more on timing and patient selection than on technical parameters. Limitations The limitation of our study is the relatively small sample size, which may limit the broader applicability of our findings. However, we have detailed information on the radiation techniques used, allowing for a more thorough analysis of the impact of adjuvant RT on LR in our study. Conclusion Our study confirms that malignant PTs have a higher LR rate compared to borderline PTs. While adjuvant RT did not significantly reduce LR, a trend toward improved local control was observed in malignant cases, suggesting a potential benefit in selected high-risk patients, particularly those with positive margins or large tumors. Additionally, delayed RT was associated with an increased risk of recurrence, indicating that early initiation of RT may be beneficial for patients undergoing adjuvant treatment. However, further research is needed to better define the optimal timing and patient selection criteria for RT in this setting. Given the lack of prospective trials in PTs, future research should focus on establishing multicenter collaborations to improve data collection and treatment standardization. This study may also contribute to defining the optimal timing of adjuvant radiotherapy, ensuring that treatment is initiated in a timely manner to maximize local control and reduce recurrence risk. Declarations Conflict of interest : All authors declare that they have no conflicts of interest to disclose. References World Health Organization (1981), Histologic typing of breast tumors, 2nd edn. WHO, Geneva Histological typing of breast tumors. Tumori. 1982;68(3):181–98. PMID:6291202, https://www.ncbi.nlm.nih.gov/pubmed/6291202. Strode M, Khoury T, Mangieri C, Takabe K (2017) Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast 33:91–96 National Comprehensive Cancer Network. Breast Cancer (Version 1. 2025). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 25 Feb 2025 Barth RJ Jr., Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant Phyllodes tumors. 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Eur J Surg Oncol 27(8):723–730 Supplementary Files Supplementrevised3.2025.docx Cite Share Download PDF Status: Published Journal Publication published 22 May, 2025 Read the published version in Breast Cancer → Version 1 posted Reviewers agreed at journal 26 Mar, 2025 Reviewers invited by journal 26 Mar, 2025 Editor assigned by journal 26 Mar, 2025 First submitted to journal 25 Mar, 2025 Editorial decision: Minor Revision 03 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5774733","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":434346134,"identity":"6309b42a-e061-4a24-bc8a-eb23b425c848","order_by":0,"name":"Amonthep Charoenyothakun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYBACgwPMDch8mwQwlVCATwsjUEsCnJ+WwMAG0mJAvJbDEC0M+LQcP9j2mPdHHQO/RI7xi487zufxy3cnfnhgwCDPL3YAqxazM4ntxjwJbAySPWfMLGeeuV0s2ca7WQLoMMOZsxOwazmQ2CbNk8ADtK7HzJi37XbihmO8G0BaEgxu49By/iFIiwSDwWEeM+O/bedAWjb/wKfF/gbYFgOQLcaPGdsOgLRsw2uL5Y2HbZJzgEEr2XOsjLG3LTlxZlvuNosEAwmcfjE4n3xM4o0NKMSSN3/42WaX2M98dvPNHxU28vzS2LXAQH0DA4eZBJKABE6lSID98QdilI2CUTAKRsHIAwD5aGHni8aSzAAAAABJRU5ErkJggg==","orcid":"","institution":"Chulalongkorn University Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Amonthep","middleName":"","lastName":"Charoenyothakun","suffix":""},{"id":434346135,"identity":"41f96c9b-a1cb-4afd-9e2c-12338e5c42ad","order_by":1,"name":"Kanjana Shotelersuk","email":"","orcid":"","institution":"Chulalongkorn University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kanjana","middleName":"","lastName":"Shotelersuk","suffix":""},{"id":434346136,"identity":"8e61478a-7669-4688-a00d-e9e5792c7177","order_by":2,"name":"Chonnipa Nantavithya","email":"","orcid":"","institution":"Chulalongkorn University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chonnipa","middleName":"","lastName":"Nantavithya","suffix":""},{"id":434346137,"identity":"ea848f69-5eb1-4c62-b15b-b48aec78d681","order_by":3,"name":"Kitwadee Saksornchai","email":"","orcid":"https://orcid.org/0000-0002-5461-8661","institution":"Chulalongkorn University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kitwadee","middleName":"","lastName":"Saksornchai","suffix":""}],"badges":[],"createdAt":"2025-01-06 14:39:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5774733/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5774733/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12282-025-01725-3","type":"published","date":"2025-05-22T15:57:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79346951,"identity":"6f37c6c3-5ca2-4f89-a215-d09043ecb700","added_by":"auto","created_at":"2025-03-27 09:46:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64307,"visible":true,"origin":"","legend":"\u003cp\u003eCumulative of LRFS after surgery in borderline and malignant PTs\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5774733/v1/f1798e6daa1d6f010a31cc9e.png"},{"id":79346952,"identity":"ba0e401c-9fde-4218-99a4-af6b8ed5a554","added_by":"auto","created_at":"2025-03-27 09:46:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61372,"visible":true,"origin":"","legend":"\u003cp\u003eCumulative of LRFS after surgery by treatment modality for malignant PTs\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5774733/v1/574fb0a31f95f66fd3cd356b.png"},{"id":83460614,"identity":"d86b6447-4e97-46c2-bcd7-c389a9d96e4d","added_by":"auto","created_at":"2025-05-26 16:12:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":769966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5774733/v1/271c5127-8b52-496b-b5d0-8de532fb2c34.pdf"},{"id":79346958,"identity":"c942342e-7275-4009-9961-92f05a9f0dc3","added_by":"auto","created_at":"2025-03-27 09:46:10","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":122268,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementrevised3.2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-5774733/v1/b768c0049377b3435120fc8e.docx"}],"financialInterests":"","formattedTitle":"The impact of Adjuvant radiotherapy on Borderline and Malignant Phyllodes Tumors of The Breast","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhyllodes tumors (PTs) are rare fibroepithelial lesions that account for 0.3\u0026ndash;1% of breast neoplasms. They are distinguished by enhanced stromal proliferation and \"leaf-like\" tumor cell growth patterns. The World Health Organization (WHO) guideline classifies PTs into benign, borderline, and malignant subtypes based on histopathologic characteristics [1, 2]. The malignant PTs account for 20% of all PTs and have a higher tendency to behave aggressively and metastasis [3]. Breast-conserving surgery (BCS) or total mastectomy (TM) with surgical margins of \u0026ge;\u0026thinsp;1 cm are the mainstays of the curative treatment of PTs [4, 5]. According to recent reports of borderline and malignant PTs, the local recurrence rate (LRR) within 2 years after surgery is 21% and 36%, and distant metastases (DM) are 25% and 40%, respectively [5, 6]. The most common sites of metastasis are the lungs (66%), bone (28%), and brain (9%). Despite the generally favorable prognosis of PTs, the 5-year cancer-specific survival rates vary by subtype, ranging from approximately 80\u0026ndash;92% for borderline and malignant PTs, with malignant subtypes exhibiting a higher risk of recurrence and metastasis.[7, 8].\u003c/p\u003e \u003cp\u003eDue to the high LR rates observed in borderline and malignant PTs, adjuvant RT has been increasingly used to enhance local control. While surgery remains the primary treatment, the role of RT in reducing recurrence risk has been explored in several studies, with varying conclusions. Barth et al.'s study, the only prospective study to date, reports excellent local control (LC) for borderline and malignant PTs treated with margin-negative BCS and adjuvant RT [5]. Gnerlich et al., an analysis of cases collected from NCDB from 1998\u0026ndash;2009, adjuvant RT increased time to LR and a significant decrease in LR in women who received adjuvant RT versus surgery alone for malignant PTs but without a significant improvement in disease-free survival (DFS) or overall survival (OS) [7]. Belkacemi et al., demonstrated that adjuvant RT resulted in a higher 10-year LC rate for borderline and malignant PTs (86% with radiation versus 59% without radiation) [6]. Several retrospective studies have shown an improvement in LC; however, results are inconclusive and the indications for adjuvant local therapies remain debatable. Due to the rarity of the disease entity and especially the small numbers of borderline and malignant subtypes that received adjuvant RT, there were no randomized clinical trials and no studies involving the radiation technique.\u003c/p\u003e \u003cp\u003eThis study aims to assess the efficacy of radiotherapy in patients with borderline and malignant PTs, identify factors associated with increased risk of LR, define subgroups of patients that may potentially benefit from adjuvant RT, and collect data involving the radiation technique.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e The study provides a retrospective review of all patients with borderline and malignant PTs of the breast who underwent surgery (BCS or TM) between 2012 and 2021 at our institute. Patients were excluded if they had: (1) recurrent phyllodes tumors or distant metastasis at diagnosis, (2) a history of other malignancies before or after PTs diagnosis, (3) a follow-up duration of less than two years, (4) prior radiation therapy to the breast, or (5) incomplete medical records preventing full data analysis. After IRB approval (IRB No. 0061/66), the medical records were examined for clinical data, tumor characteristics, treatment factors, and follow-up status. The primary endpoint was LRR. Kaplan-Meier and Cox regression models were conducted to determine LRR and the risk factors correlated with an increased risk of LR. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median follow-up was 4.3 years. 102 patients were analyzed; 50 patients had borderline, and 52 patients had malignant PTs. Key variables examined included age at diagnosis, tumor size, surgical interventions, margin status, adjuvant RT, radiation techniques, dosage, fractionation, and radiation timing after surgery, as well as follow-up duration.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The median age at diagnosis was similar across groups: total populations (48 years), borderline (46 years), and malignant (49 years), with no statistically significant difference (P = 0.053). The median tumor size was significantly larger in the malignant group (12 cm) compared to the borderline group (5.6 cm), with a P-value of \u0026lt;0.001. Tumor size \u0026lt; 10 cm was more common in the borderline group (78%), whereas tumor size \u0026gt; 15 cm was predominantly in the malignant group (34.6%). BCS was more common in the borderline group (78%), while TM was more frequent in the malignant group (75%); this difference was statistically significant (P \u0026lt; 0.001). Most patients had margins \u0026ge; 1 cm (total: 80.4%); no significant difference was observed in margin status across the groups (P = 0.300). Adjuvant radiation was administered to 78.9% of patients in the malignant group compared to 8% in the borderline group, with a P-value of \u0026lt;0.001, a significant difference. Radiation technique (3D vs. IMRT/VMAT), total radiation dose, and fractionation were not significantly different between groups. The median timing for radiation after surgery was slightly longer for the borderline group but not significantly different (P = 0.130). Median follow-up duration was significantly longer in the borderline group (5.0 years) compared to the malignant group (3.7 years), with a P-value of 0.046. Details in Table 1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eCharacteristics of patient\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eTotal(N=102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eBorderline(N=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMalignant(N=52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAge (years) at diagnosis, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e48 (40-55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46 (37-53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e49 (42.5-58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTumor size (cm) , Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e8 (4.8-14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.6 (4.1-8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12 (6.6-17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTumor size (cm), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026lt; 10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e58 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e10-15\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e23 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt;15\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e21 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSurgery, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBCS\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e52 (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e13 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eTM\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e50 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMargin, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026ge; \u0026nbsp;1 cm\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e82 (80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e40 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e42 (80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026lt; \u0026nbsp;1 cm\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e15 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePositive\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e5 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAdjuvant radiation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e45 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e41 (78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eRadiation Technique, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e3D\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e34 (75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30 (73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eIMRT/VMAT\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e11 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal dose (Gy) , median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e60 (51-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e55 (50-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60 (51-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal dose (Gy), n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e50-59\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e13 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e60-66\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e32 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30 (73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBolus (Fx), \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e0\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e24 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21 (51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e1-10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e12 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt;10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e9 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eDose/Fx (Gy/Fx ), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e2\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e43 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39 (95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e3\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e2 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eRadiation timing after surgery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(Wk) median \u0026nbsp; \u0026nbsp; ( IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e8 (4-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (8-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (4-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eYear of follow-up, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e4.3 (2.5-5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.0 (2.7-6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.7 (2.3-5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: BCS= breast conserving surgery, TM= total mastectomy, 3D= Three dimension conformal Radiotherapy , IMRT/VMAT= Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy, Fx = Fractions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eThere was no significant difference in LR between different surgery types, with P-values of 0.443 for borderline cases and 0.674 for malignant cases.\u0026nbsp;\u003c/u\u003eRegarding the margin status, patients with a margin less than 1 cm and a positive margin had a significantly higher LR in malignant patients (P = 0.044). \u003cu\u003eAdjuvant RT does not result in a difference in LR for either borderline or malignant patients.\u003c/u\u003e \u003cu\u003eHowever, there has been a trend toward a reduction in the number of recurrence cases when adding radiotherapy to malignant cases (12.2% vs. 36.4% without RT, P = 0.081).\u003c/u\u003e There were no significant differences in recurrence rates between RT technique, total dose, bolus administration, and dose per fraction (Gy/Fx). Details in Table 2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eProportion of local recurrence rate by groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eTotal(N=102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBorderline (N=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMalignant(N=52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eOverall\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e11 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eSurgery, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBCS\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5/52 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/39 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3/13 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eTM\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6/50 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/11 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6/39 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eMargin, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt; 1 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7/82 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/40 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5/42 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt; 1 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3/15 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/9 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3/6 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; - \u0026nbsp; \u0026nbsp; \u0026nbsp; Positive\u003c/p\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1/5 (10)\u003c/p\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1/4(25)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eTreatment modality, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026nbsp;BCS\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3/40 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/37 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1/3 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBCS+RT\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2/12 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/10 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eTM\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3/17 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/9 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3/8 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eTM+RT\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3/33 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3/31 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.088\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eAdjuvant radiation, \u0026nbsp;n (%) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6/57 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/46 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4/11 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eYes\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5/45 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/4 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5/41 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.081\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eRadiation Technique, \u0026nbsp;n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e3D\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2/34 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/4 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/30 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eIMRT/VMAT\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3/11 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3/11 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eTotal dose (Gy), n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e50-59\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1/13 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1/11 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e60-66\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4/32 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4/30 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBolus (Fx), \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e0\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2/24 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/21 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e1-10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2/12 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2/11 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt;10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1/9 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1/9 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eDose/Fx (Gy/Fx ) , \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e2\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5/43 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/4 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5/39 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e3\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: BCS= breast conserving surgery, TM= total mastectomy, RT = Adjuvant radiation therapy, 3D= Three dimension conformal Radiotherapy , IMRT/VMAT= Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy, Fx = Fractions\u003c/p\u003e\n\u003cp\u003eFor patients with borderline and malignant PTs, the 5-year local recurrence-free survival rate (LRFS) after surgery was 100% and 81.7%, respectively.\u0026nbsp;There was a statistically significant difference in LRFS after surgery between borderline and malignant patients (P = 0.010). (Fig 1)\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference for 5-year LRFS after complete treatment (either surgery alone or surgery with RT) for all groups (BCS, BCS+RT, TM, and TM+RT were 97.5%, 83.3%, 81.5%, and 90.9%, respectively, P = 0.508). (Fig 1S)\u003c/p\u003e\n\u003cp\u003eThe 5-year LRFS for malignant patients was 66.7% with BCS alone, 80% with BCS+RT, 62.5% with TM alone, and 90.3% with TM+RT, with no statistically significant differences between these groups. (P= 0.286) (Fig 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrognostic factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur analysis revealed a significant association between tumor subtype and the risk of LR.\u0026nbsp;Malignant PTs were associated with a much higher risk of LR compared to borderline PTs, with a hazard ratio (HR) of 5.7 (95% CI 1.22-27.36, P=0.027) in the univariate analysis and an adjusted HR of 12.85 (95% CI 1.81-91.07, P=0.011) in the multivariate analysis. Age at diagnosis did not significantly affect risk of LR, with patients over 50 showing no increased risk compared to those 50 or younger (HR 1.54, 95% CI 0.40-5.89, P=0.525).\u0026nbsp;Positive margins showed a trend toward higher recurrence, though this was not statistically significant.\u0026nbsp;In terms of other factors, tumor size, surgery type (BCS vs. TM), and adjuvant RT did not demonstrate significant associations with the risk of LR in either univariate or multivariate analysis.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eThe timing of adjuvant RT is significantly associated with LR for malignant PT patients. Delaying RT beyond 12 weeks post-surgery resulted in a higher recurrence rate, with a hazard ratio (HR) of 18.9 (95% CI 2.09-170.6, P = 0.009) in the univariate analysis and an adjusted HR of 18.19 (95% CI 12.01-165 , P=0.010) in the multivariate analysis.\u003c/u\u003e RT technique, total dose, and bolus administration did not significantly influence local recurrence rates in our analysis.\u003cu\u003e\u0026nbsp;These findings are summarized in Tables 3, 1S, and 2S.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u0026nbsp; Risk factor associated with LR for malignant patient who received RT after surgery (N = 41)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eUnivariate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eHR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eaHR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eAge \u0026nbsp;at diagnosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026le; 50\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e3.44 (0.38-30.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt; 50\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eTumor size (cm), group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026lt; 10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026ge; 10\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.65 (0.11-3.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBCS\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;TM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.42 (0.07-2.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eMargin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNegative\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePositive\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.17 (0.22-6.296)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eRT Technique \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e3D\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eIMRT/VMAT\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e4.35 (0.72-26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e4.01(0.66-24.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eTotal dose (Gy),n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e50-59\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e60-66\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.76 (0.20-15.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eBolus (Fx)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e0\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt;=1\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.57 (0.26-9.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eRadiation timing after surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026lt; 12 weeks\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026ge; 12 weeks\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e18.9 (2.09-170.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e18.19 (12.01-165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUnivariate and multivariate were evaluated with Cox regression model. Multivariate were developed by covariate with P\u0026lt; 0.2 from univariate.\u003c/p\u003e\n\u003cp\u003eAbbreviations :HR = Hazard \u0026nbsp;ratio, aHR = \u0026nbsp;adjusted Hazard \u0026nbsp;ratio, BCS= breast conserving surgery, TM= total mastectomy, RT = Adjuvant radiation therapy, 3D= Three dimension conformal Radiotherapy , IMRT/VMAT= Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy, Fx = Fractions\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective analysis included a cohort of 102 patients, consisting of 50 with borderline PTs and 52 with malignant PTs, with a median follow-up duration of 4.3 years. Our patients\u0026rsquo; characteristics were largely consistent with those reported in other studies, particularly the younger age group. The median tumor size in our study was larger than in other retrospective studies.[10, 11], which median tumor sizes typically ranged from between 5 and 7.2 cm. Also, the proportion of malignant PTs (greater than 10 cm) was significantly higher compared to borderline PTs. This larger tumor size is associated with more aggressive surgical approaches, with a higher likelihood of TM for malignant cases. In our study, the majority of patients with malignant PTs underwent TM, compared to a much smaller proportion of borderline PT cases (75% vs. 11%, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eIn our study, the 5-year LRFS rates were 100% for borderline phyllodes tumors (PTs) and 81.7% for malignant PTs. These rates are comparable to, and in some cases better than, those reported in other studies. For instance, Gnerlich et al. [7] reported 5-year LRFS rates of 94% for borderline PTs and approximately 75% for malignant PTs, indicating slightly lower rates for both groups compared to our findings.\u003c/p\u003e\n\u003cp\u003eThe LRR in our study was lower than those reported in other studies, with 4% for borderline and 17.3% for malignant PTs. According to the WHO 2012 classification, LR can occur in any PT subtype, with an overall prevalence of 21%. The reported recurrence rates vary from 10-17% for benign PTs, 14-25% for borderline PTs, and 23-30% for malignant PTs [6, 11, 14]. One possible explanation for the lower LRR in our study is \u003cu\u003ethe high rate of wide resection margins\u003c/u\u003e, with over 80% of cases having a margin greater than 1 cm. Although margin width was not a significant factor for LRR in our study, our results did show that close or positive surgical margins were associated with a higher LRR in malignant PTs. Other studies, such as those by Barrio et al. [12] and Tremblay-LeMay et al. [15], have identified margin status as a key factor influencing local recurrence.\u003c/p\u003e\n\u003cp\u003eSeveral studies have shown the efficacy of adjuvant RT in reducing LRR in malignant PTs. For example, Barth et al. [5], the only prospective study to date, report excellent LC for malignant PTs treated with margin-negative BCS and adjuvant RT, and a retrospective analysis by Gnerlich et al. [7] demonstrated that adjuvant RT significantly decreased LRR in patients with malignant PTs. \u003cu\u003eIn our study, we observed a trend toward lower local recurrence rates (LRR) in malignant PT patients who received adjuvant RT compared to those who did not (12.2% vs. 36.4%, p = 0.081), suggesting a potential benefit in selected high-risk cases.\u003c/u\u003e This result is consistent with other studies [5, 6, 7] and indicates the efficacy of adjuvant RT in reducing LRR, particularly in malignant PTs.\u003c/p\u003e\n\u003cp\u003eThe timing of adjuvant RT administration post-surgery was a significant factor influencing LR risk in patients with malignant PTs in our study. Patients who received RT more than 12 weeks after surgery had a significantly higher LRR compared to those who received it earlier.\u0026nbsp;\u003cu\u003eTo our knowledge, our study is one of the few to report on RT timing in phyllodes tumors as a potential factor influencing local control, emphasizing the importance of early initiation.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOther factors, such as patient age, tumor size, type of surgery, resection margin, and radiation technique or dose, did not demonstrate significant associations with LR risk in patients with borderline and malignant PTs. \u0026nbsp;These findings are consistent with, but also differ in some respects from, other studies: Patient age, Macdonald et al. [8] similarly reported that age was not a significant predictor of recurrence in malignant PTs. However, some studies, such as Chaney et al. [16], suggested that younger age might be associated with higher recurrence rates, possibly due to biological differences in tumor behavior. Tumor size, Kapiris et al. [17] reported that tumor size has an effect on LC and survival in patients with malignant subtypes of PT, with a significantly increased risk for tumors larger than 10 cm. Type of Surgery and Resection Margin, Barrio et al. [12] also concluded that the choice of surgery (lumpectomy or mastectomy) is less critical than achieving negative surgical margins. NCCN [4] and The WHO classification [14] emphasizes the importance of achieving negative margins to reduce recurrence rates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eRegarding RT technique and dose, our study found no significant differences in LRR between 3D and IMRT/VMAT, or between radiation doses, which is consistent with previous findings by Belkacemi et al. [6] and Gnerlich et al. [7].\u003c/u\u003e This suggests that the effectiveness of RT may depend more on timing and patient selection than on technical parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003elimitation of our study is the relatively small sample size, which may limit the broader applicability of our findings. However, we have detailed information on the radiation techniques used, allowing for a more thorough analysis of the impact of adjuvant RT on LR in our study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study confirms that malignant PTs have a higher LR rate compared to borderline PTs. While adjuvant RT did not significantly reduce LR, a trend toward improved local control was observed in malignant cases, suggesting a potential benefit in selected high-risk patients, particularly those with positive margins or large tumors.\u003c/p\u003e\n\u003cp\u003eAdditionally, delayed RT was associated with an increased risk of recurrence, indicating that early initiation of RT may be beneficial for patients undergoing adjuvant treatment. However, further research is needed to better define the optimal timing and patient selection criteria for RT in this setting.\u003c/p\u003e\n\u003cp\u003eGiven the lack of prospective trials in PTs, future research should focus on establishing multicenter collaborations to improve data collection and treatment standardization. This study may also contribute to defining the optimal timing of adjuvant radiotherapy, ensuring that treatment is initiated in a timely manner to maximize local control and reduce recurrence risk.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: All authors declare that they have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (1981), Histologic typing of breast tumors, 2nd edn. WHO, Geneva\u003c/li\u003e\n\u003cli\u003eHistological typing of breast tumors. Tumori. 1982;68(3):181\u0026ndash;98. PMID:6291202, https://www.ncbi.nlm.nih.gov/pubmed/6291202.\u003c/li\u003e\n\u003cli\u003eStrode M, Khoury T, Mangieri C, Takabe K (2017) Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast 33:91\u0026ndash;96\u003c/li\u003e\n\u003cli\u003eNational Comprehensive Cancer Network. Breast Cancer (Version 1. 2025). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 25 Feb 2025\u003c/li\u003e\n\u003cli\u003eBarth RJ Jr., Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant Phyllodes tumors. Ann Surg Oncol. 2009;16(8):2288\u0026ndash;94.\u003c/li\u003e\n\u003cli\u003eBelkacemi Y, Bousquet G, Marsiglia H, Ray-Coquard I, Magne N, Malard Y, Lacroix M, Gutierrez C, Senkus E, Christie D, et al. Phyllodes tumor of the breast. Int J Radiat Oncol Biol Phys. 2008;70(2):492\u0026ndash;500.\u003c/li\u003e\n\u003cli\u003eGnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant Phyllodes tumors: analysis of the National Cancer Data Base, 1998-2009. Ann Surg Oncol. 2014;21(4):1222\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eMacdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the surveillance, epidemiology, and end results (SEER) program. Cancer. 2006;107(9):2127\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eAdesoye T, Neuman HB, Wilke LG, Schumacher JR, Steiman J, Greenberg CC (2016) Current trends in the management of phyllodes tumors of the breast. Ann Surg Oncol 23(10):3199\u0026ndash;3205\u003c/li\u003e\n\u003cli\u003eMokbel K, Price RK, Mostafa CA, Wells CA, Carpenter R: Phyllodes tumour of the breast: a retrospective analysis of 30 cases. Breast. 1999, 8:278-281. 10.1054/brst.1999.0058\u003c/li\u003e\n\u003cli\u003eJang JH, Choi MY, Lee SK, et al.: Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012, 19:2612-2617. 10.1245/s10434-012 2307-5\u003c/li\u003e\n\u003cli\u003eBarrio, A. V., Clark, B. D., Goldberg, J. I., Hoque, L. W., Bernik, S. F., \u0026amp; Flynn, S. D. (2007). Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Annals of Surgical Oncology, 14(9), 2961-2970.\u003c/li\u003e\n\u003cli\u003eYu, Chia-Yuna; Huang, Tsai-Weib; c; Tam, Ka-Waic; d, e,*. Management of phyllodes tumors: A systematic review and meta-analysis of real-world evidence. International Journal of Surgery 107:p 106969, November 2022.\u003c/li\u003e\n\u003cli\u003eLakhani SR, Ellis IO, Schnitt SJ, Tan PH, van der Vijver MJ. WHO Classification of Tumours of the Breast, 4th ed. IARC Lyon; 2012. p. 142.\u003c/li\u003e\n\u003cli\u003eTelli ML, Horst KC, Guardino AE, Dirbas FM, Carlson RW (2007) Phyllodes tumors of the breast: natural history, diagnosis, and treatment. J Natl Compr Canc Netw 5(3):324\u0026ndash;330\u003c/li\u003e\n\u003cli\u003eChaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE, Hunt KK. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000 Oct 1;89(7):1502-11.\u003c/li\u003e\n\u003cli\u003eKapiris I, Nasiri N, A\u0026rsquo;Hern R, Healy V, Gui GP (2001) Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol 27(8):723\u0026ndash;730\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"breast-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"brca","sideBox":"Learn more about [Breast Cancer](http://link.springer.com/journal/12282)","snPcode":"12282","submissionUrl":"https://www.editorialmanager.com/brca/default2.aspx","title":"Breast Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5774733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5774733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Borderline and malignant phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast and have a high local recurrence rate (LRR). \u003cu\u003eThe use of adjuvant radiation therapy (RT) for local control has increased in recent decades, but its impact on outcomes remains uncertain.\u003c/u\u003e We aim to assess the efficacy of radiotherapy and define the factors that are associated with local recurrence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Methods\u003c/strong\u003e: The study provides a retrospective review of all patients with borderline and malignant phyllodes tumors of the breast who underwent surgery between 2012 and 2021 at our institute. Medical records were examined for clinical data, tumor characteristics, treatment factors, and follow-up status. The primary endpoint was LRR. Kaplan-Meier and Cox regression models were conducted to determine LRRs and the risk factors correlated with an increased risk of LR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The median follow-up was 4.3 years. A total of 102 patients were analyzed: 50 with borderline and 52 with malignant PTs. Patients who are in the malignant group tend to have a larger tumor size (larger than 10 cm) (63.5% vs. 22% of the borderline, p\u0026lt;0.001). The majority of patients with malignant PT underwent mastectomy (TM) (75% vs. 11% of borderline, p\u0026lt;0.001) and had adjuvant RT (78.9% vs. 8% of borderline, p\u0026lt;0.001). There were two borderline patients who had LR, which occurred after 5 years of follow-up. For malignant PTs, all of those recurred before the 5-year follow-up period. Among patients who did not have adjuvant RT, those with malignant PTs experienced a significantly greater rate of LR compared to those with borderline PTs (36.4% vs. 4.4%, p \u0026lt; 0.010). \u003cu\u003eIn patients with malignant subtypes, adjuvant RT was associated with a lower local recurrence rate however, the difference was not statistically significant (12.2% vs. 36.4% without RT, p=0.081).\u003c/u\u003e The 5-year LRRs of patients with malignant PTs who underwent breast-conserving surgery (BCS), BCS with RT, TM, and TM with RT were 33.3%, 20%, 37.5%, and 9.1%, respectively (p=0.286). In multivariate analysis, the subtype of the tumor (borderline vs. malignant) was the only risk factor that was associated with LR in all patients (p=0.011). Age, tumor size, type of surgery, receiving adjuvant RT, and resection margin were not shown to be correlated with LR in patients with malignant subtypes. For patients who have malignant PTs and underwent adjuvant RT, the timing of RT after surgery (later than 12 weeks) was the only risk factor associated with LR (p=0.009). The use of different radiation techniques (3D vs. intensity modulated radiation therapy), radiation doses (50–60 Gy vs. 60–66 Gy), or the application of a bolus did not show an evident association with LR in this group of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis is to confirm that\u003cstrong\u003e \u003c/strong\u003epatients with malignant PTs had a higher LRR compared to borderline PTs. In our study, a statistically significant benefit of adjuvant RT was not observed in either borderline or malignant PTs. However, there was a trend toward the efficacy of adjuvant RT in reducing the incidence of LR in cases of malignant PTs.\u003c/p\u003e","manuscriptTitle":"The impact of Adjuvant radiotherapy on Borderline and Malignant Phyllodes Tumors of The Breast","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 09:46:05","doi":"10.21203/rs.3.rs-5774733/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-03-26T23:32:49+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-26T13:57:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-26T12:38:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Breast Cancer","date":"2025-03-25T09:48:24+00:00","index":"","fulltext":""},{"type":"decision","content":"Minor Revision","date":"2025-02-04T01:11:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"breast-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"brca","sideBox":"Learn more about [Breast Cancer](http://link.springer.com/journal/12282)","snPcode":"12282","submissionUrl":"https://www.editorialmanager.com/brca/default2.aspx","title":"Breast Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4f4993ae-3881-4533-9707-e2aae30626ee","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T16:08:43+00:00","versionOfRecord":{"articleIdentity":"rs-5774733","link":"https://doi.org/10.1007/s12282-025-01725-3","journal":{"identity":"breast-cancer","isVorOnly":false,"title":"Breast Cancer"},"publishedOn":"2025-05-22 15:57:33","publishedOnDateReadable":"May 22nd, 2025"},"versionCreatedAt":"2025-03-27 09:46:05","video":"","vorDoi":"10.1007/s12282-025-01725-3","vorDoiUrl":"https://doi.org/10.1007/s12282-025-01725-3","workflowStages":[]},"version":"v1","identity":"rs-5774733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5774733","identity":"rs-5774733","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}