EORTC Amaros Trial

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The EORTC AMAROS trial:
    • Was a randomized controlled trial comparing completion axillary lymph node dissection (ALND) versus axillary radiotherapy (ART):
      • In women with clinical T1 to T2, N0 who were found to have a positive sentinel lymph node upon undergoing sentinel lymph node biopsy
    • Axillary RT was to levels I to III and SCV fossa:
      • To 50 Gy / 25 fractions
    • The primary endpoint was:
    • Non-inferiority of 5-year axillary recurrence
  • The 5-year axillary lymph node recurrence rate:
    • As 0.43% in the ALND group and 1.19% in the ART group (p=non-significant), with authors concluding that ALND and ART offer excellent and comparable axillary control in this set of patients
  • Of note, non-randomized patients with a negative sentinel lymph node biopsy had a similar axillary recurrence rate of 0.8%
  • Disease-free and overall survival were similar between the two arms
  • Lymphedema:
    • Was increased in those receiving ALND (23% vs. 11%, p<0.001 with clinical signs; 13% vs. 5%, p=0.0009 with arm circumference > 10%)
  • This result echoes findings of the ACOSOG Z0011 trial with low rates of axillary recurrence while omitting ALND
  • Those offering their expert opinion have agreed that results from these two randomized trials support the omission of ALND in patients with a clinically node negative axilla and a low burden of node positive disease found upon sentinel lymph node dissection
  • References
    • Donker M, Van Teinhoven G, Straver M, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303-1310.
    • Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426-432.
    • Mahmoud O, Haffty B. Regional nodal management in the light of the AMAROS trial. Ann Transl Med. 2015; 3(7):88.
Unknown's avatar

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.

Leave a comment