The European Organisation for Research and Treatment of Cancer (EORTC) After Mapping of the Axilla, Radiation or Surgery? (AMAROS) Trial

• In the past, patients with positive sentinel nodes have generally been treated with:
  • Axillary lymph node dissection (ALND)
• Side effects of ALND include:
  • Lymphedema:
    • In up to 40% of patients
• The AMAROS trial:
  • Is a phase III prospective, multicenter non-inferiority study:
    • Comparing ALND with axillary radiotherapy (ART)
  • The primary objective of the trial:
    • Is to prove equivalent locoregional control:
    • With reduced morbidity for ART
  • The SN detection rate:
    • With radioactive tracer and blue dye combined:
      • Was 97%
  • The two treatment arms were comparable:
    • With regard to age, tumor type, tumor size, grade, and adjuvant therapy
  • Both ALND and ART after a positive sentinel node biopsy:
    • Provided excellent and comparable regional control
  • Median follow-up of 6.1 years
  • The 5-year axillary recurrence rate was:
    • 0.54% after ALND and
    • 1.03% after ART
  • The axillary recurrence rate:
    • After a negative sentinel node biopsy:
      • was 0.8%
  • There were no significant differences between treatment arms:
    • With respect to overall survival:
      • 93.27% ALND
      • 92.52% ART
        • P=0.3386
    • Disease-free survival:
      • 86.90% ALND
      • 82.65% ART
        • P=0.1788
  • Lymphedema:
    • Was found significantly more often after ALND than ART:
      • Patient perceived (subjective) lymphedema:
        • 23% versus 11%
      • Measured (objective):
        • 13% versus 6% after 5 years of follow-up
          • P<0.0001

REFERENCES

1. Rutgers EJ, Donker M, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: final analysis of the EORTC AMAROS trial (10981/22023). J Clin Oncol. 2013;31 (suppl; abstr LBA1001). http://meetinglibrary.asco.org/content/109779-132. Accessed November 7, 2013.
2. Straver ME, Meijnen P, Tienhoven GV, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol. 2010;17:1854-1861.

#Arrangoiz #BreastSurgeon #BreastCancer #Surgeon #CancerSurgeon #SurgicalOncologist #Teacher