In the surgical group, the mean number of nodes removed was 15 (range, 12–20). About 60% had macrometastasis, and 30% had micrometastasis isolated tumor cells were found in about 10%. The mean number of sentinel nodes removed was two in both arms. About 86% had radiotherapy: either to the breast after breast conservation, or some to the chest wall after mastectomy. Approximately 60% had chemotherapy, 78% had hormonal therapy, 6% had immunotherapy, and 9% had no systemic therapy. Nearly 80% had breast-conserving surgery, and about 17.5% had mastectomy. ![]() Preoperative ultrasound of the axilla was performed in about 60%.īaseline treatment characteristics were also comparable. The median tumor size was 17 mm about 23% had grade 1 disease, 46% had grade 2 disease, and 27% had grade 3 disease. About 40% were premenopausal, and 56% were postmenopausal. Data on arm morbidity and quality of life were updated from the 5-year analysis.Īt baseline, both study arms were comparable. Rutgers presented the 10-year results focused solely on patients with a positive sentinel node. The United States has been much slower than Europe to adopt axillary radiation therapy and to de-escalate surgery for this population.Īt the 2018 San Antonio Breast Cancer Symposium, Dr.These results, taken together with results of the ACOSOG Z0011 trial, suggest that axillary lymph node dissection is not necessary in early breast cancer with up to two positive sentinel nodes.Axillary radiation therapy reduced the rate of lymphedema compared with axillary lymph node dissection.Axillary radiation therapy and axillary lymph node dissection provide excellent locoregional control and comparable rates of survival and recurrence.The results were not universally accepted,” Dr. “At the time, the study was criticized for being underpowered to show a difference, because there were too few events and the follow-up was too short. There was less lymphedema with axillary radiation therapy. No differences were found between surgery and radiation therapy, with few relapses in both arms. The 5-year outcomes were reported in 2013. If the sentinel node was positive (n = 1,425, 29.7%), they were further randomly assigned to axillary lymph node dissection (n = 744) or axillary radiation therapy (n = 681). All patients had breast conservation surgery or mastectomy and then underwent mapping of the axilla and sentinel node biopsy. Between 20, AMAROS enrolled 4,806 patients of any age with invasive breast cancer tumors between 0.5 and 5 mm that were clinically node negative. ![]() Other trials of unsuspicious nodes have shown that axillary radiation therapy provides good locoregional control, providing a rationale for the study. However, if it is positive, axillary lymph node dissection is typically performed in the United States, but this surgery has side effects that can be persistent and troublesome to patients, most notably lymphedema and shoulder pain. If the sentinel node is negative, then patients do not need axillary lymph node dissection. The sentinel lymph node is the most likely to harbor metastasis and can be identified and surgically removed by using tracers that mimic the route to cancer cells from the tumor site through the lymph vessels. Rutgers, MD, of the Netherlands Cancer Institute, Amsterdam, at the 2018 San Antonio Breast Cancer Symposium. Axillary radiation therapy can be considered a standard procedure in this setting,” stated Emiel J.T. ![]() Given that we previously published 5-year data from AMAROS showing significantly more lymphedema in the surgery arm, we believe that axillary radiotherapy should be considered a good option for patients who have a positive sentinel lymph node biopsy instead of surgical axillary lymph node dissection. “Our new 10-year data show that axillary radiotherapy and axillary lymph node dissection provide excellent and comparable overall survival, distant metastasis–free survival, and locoregional control.
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