Role of Axillary Radiation without Axillary Dissection (AMAROS Study)

Rodrigo Arrangoiz MS, MD, FACS, FSSO

The international After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) study randomized 1,425 sentinel lymph node–positive patients to completion ALND or nodal field irradiation without ALND.

  • Nodal radiotherapy included axillary, supraclavicular, and low-neck fields.
  • There was no statistically significant difference in:
    • Disease-free or overall survival between the treatment arms.
  • Axillary radiotherapy was shown to have lower morbidity than ALND, with lower complication rates:
    • Specifically lower rates of lymphedema.
  • The 10-year overall survival with extensive nodal radiotherapy was 83% compared with 82% with ALND, and this difference was not statistically significant.
  • Axillary recurrence was observed in four of the 744 patients (< 1%) in the ALND group and seven of the 681 patients (1%) in the radiotherapy group, which was also not statistically significantly different.

There have been no randomized trials comparing radiotherapy with SLNB alone.

  • The axillary recurrence rate was 1% at 6 years in patients with positive sentinel nodes who received axillary radiation in the AMAROS trial.
    • This is comparable to the axillary recurrence rate of less than 2% at 10 years in the patients randomized to the sentinel lymph node–only arm of ACOSOG Z0011.
    • If the patients and axillary recurrence rates were similar with and without radiation, the utility of nodal radiation for patients with one to two positive sentinel lymph nodes is questionable.

 

Rodrigo Arrangoiz MS, MD, FACS
Cirugía General y Gastrointestinal
Michigan State University
Cirugía Oncológica
Fox Chase Cancer Center
Tumores de Cabeza y Cuello / Cirugía Endocrina
Fox Chase Cancer Center
Tumores de Cabeza y Cuello / Cirugía Endocrina
IFHNOS / Memorial Sloan Kettering Cancer Center
Maestría en Ciencias de Investigación
Drexel University
Certificado por el Colegio Americano de Cirugía
Fellow del Colegio Americano de Cirugía
Fellow de la Sociedad de Cirugia Oncológica  

Sociedad Quirúrgica S.C.
Hospital ABC Santa Fé
Av. Carlos Graef Fernández #154

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México, D.F. 05300
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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