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

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