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Axillary Radiotherapy vs Axillary Lymph Node Dissection for Sentinel Node–Positive Breast Cancer
TAKE-HOME MESSAGE
- The AMAROS trial compared the outcomes following axillary lymph node dissection (ALND) with those following axillary radiotherapy (ART) in patients with cT1–2 node-negative breast cancer with a positive sentinel node (SN) biopsy. At 5 years, ART resulted in comparable disease control with decreased morbidity. In this study, the preplanned 10-year outcomes were reported. The 10-year axillary recurrence rate was 0.93% with ALND and 1.82% with ART. There was no difference in overall survival outcomes between the groups. The rate of development of secondary cancer was higher in patients who underwent ART than in those who underwent ALND (12.1% vs 8.3%, respectively).
- ART is a good option for patients with SN-positive early breast cancer as it results in comparable locoregional control with improved morbidity when compared with ALND.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
The European Organisation for Research and Treatment of Cancer 10981-22023 AMAROS trial evaluated axillary lymph node dissection (ALND) versus axillary radiotherapy (ART) in patients with cT1-2, node-negative breast cancer and a positive sentinel node (SN) biopsy. At 5 years, both modalities showed excellent and comparable axillary control, with significantly less morbidity after ART. We now report the preplanned 10-year analysis of the axillary recurrence rate (ARR), overall survival (OS), and disease-free survival (DFS), and an updated 5-year analysis of morbidity and quality of life.
METHODS
In this open-label multicenter phase III noninferiority trial, 4,806 patients underwent SN biopsy; 1,425 were node-positive and randomly assigned to either ALND (n = 744) or ART (n = 681).
RESULTS
Per intention-to-treat analysis, 10-year ARR cumulative incidence was 0.93% (95% CI, 0.18 to 1.68; seven events) after ALND and 1.82% (95% CI, 0.74 to 2.94; 11 events) after ART (hazard ratio [HR], 1.71; 95% CI, 0.67 to 4.39). There were no differences in OS (HR, 1.17; 95% CI, 0.89 to 1.52) or DFS (HR, 1.19; 95% CI, 0.97 to 1.46). ALND was associated with a higher lymphedema rate in updated 5-year analyses (24.5% v 11.9%; P < .001). Quality-of-life scales did not differ by treatment through 5 years. Exploratory analysis showed a 10-year cumulative incidence of second primary cancers of 12.1% (95% CI, 9.6 to 14.9) after ART and 8.3% (95% CI, 6.3 to 10.7) after ALND.
CONCLUSION
This 10-year analysis confirms a low ARR after both ART and ALND with no difference in OS, DFS, and locoregional control. Considering less arm morbidity, ART is preferred over ALND for patients with SN-positive cT1-2 breast cancer.
Additional Info
Radiotherapy or Surgery of the Axilla After a Positive Sentinel Node in Breast Cancer: 10-Year Results of the Randomized Controlled EORTC 10981-22023 AMAROS Trial
J. Clin. Oncol 2022 Nov 16;[EPub Ahead of Print], SAL Bartels, M Donker, C Poncet, N Sauvé, ME Straver, CJH van de Velde, RE Mansel, C Blanken, L Orzalesi, JHG Klinkenbijl, HCJ van der Mijle, GAP Nieuwenhuijzen, SC Veltkamp, T van Dalen, A Marinelli, H Rijna, M Snoj, NJ Bundred, JWS Merkus, Y Belkacemi, P Petignat, DAX Schinagl, C Coens, G van Tienhoven, F van Duijnhoven, EJT RutgersFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.