- 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
- Lymphedema:
- 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%
- With radioactive tracer and blue dye combined:
- 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%
- After a negative sentinel node biopsy:
- 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
- With respect to overall survival:
- 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
- 13% versus 6% after 5 years of follow-up
- Patient perceived (subjective) lymphedema:
- Was found significantly more often after ALND than ART:
- Is a phase III prospective, multicenter non-inferiority study:
REFERENCES
- 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.
- 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.
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