Study shows radiotherapy and surgery provide regional control for breast cancer patients

June 3, 2013

Final analysis of the EORTC 10981-22023 AMAROS (After Mapping of the Axilla: Radiotherapy Or Surgery?) trial has shown that both axillary lymph node dissection and axillary radiotherapy provide excellent regional control for breast cancer patients with a positive sentinel node biopsy. The AMAROS trial also found that axillary radiotherapy reduces the risk of short term and long-term lymphoedema as compared to axillary lymph node dissection.

Prof. Emiel J. Rutgers of The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis in Amsterdam, the EORTC Breast Cancer Group, and principal investigator of this study says, " has become the standard procedure for assessing axillary lymph node status for cN0 patients. At the start of this trial the question was whether axillary lymph node dissection should remain the standard treatment in case of a tumor positive sentinel node."

From 2001 to 2010, 4806 patients who were diagnosed with were enrolled in this phase III non- trial, and randomized for their axillary treatment in case the sentinel node was positive. Of these, 3131 patients had negative biopsies and 250 patients had a different sentinel node outcome. Thus, out of 1425 patients with positive node, axillary lymph node dissection was to be used in 744 patients, and axillary in 681 patients.

Dr. Geertjan van Tienhoven of the Academisch Medisch Centrum - Universiteit van Amsterdam and principal investigator on behalf of the EORTC Group says, "Although axillary lymph node dissection provides excellent regional control, it was known to cause harmful side effects. Axillary radiotherapy instead of axillary lymph node dissection was hypothesized to provide comparable regional control and perhaps fewer side effects in this particular group of patients."

The primary endpoint of this EORTC trial was 5-year axillary recurrence rate. At a median follow up of 6.1 years, this rate was 0.54% (4 out of 744 patients) after axillary lymph node dissection and 1.03% (7 out of 681 patients) after axillary radiotherapy. Due to the unexpectedly low number of events, the non-inferiority test was underpowered. The axillary recurrence rate for patients with a negative sentinel node biopsy was 0.8% (25 out of 3131 patients).

Secondary endpoints were overall survival, disease-free survival, quality of life, shoulder movement and lymphoedema at one and five years. No significant differences in overall or disease free survival were observed between the two treatment arms. Five year estimates for overall survival were 93.3% for the arm receiving axillary lymph node dissection and 92.5% for patients in the axillary radiotherapy arm (p=0.34), and for disease-free survival the five year estimates were 86.9% for axillary lymph node dissection and 82.6% for axillary radiotherapy (p=0.18).

Lymphoedema, a swelling of tissue (typically occurring in the arm), occurred more often following axillary lymph node dissection, 40% at one year and 28% at five years, than after axillary radiotherapy, 22% at one year and 14% at five years (p<0.0001)

There was a trend, albeit non-significant, towards more impairment of shoulder movement in the first year after axillary radiotherapy.

Both results were compatible with two patient reported quality of life items in the arm symptom scale: swelling, where patients in the axillary radiotherapy fared better, and mobility, where patients in the axillary lymph node dissection arm fared better.

In this group of with a metastasis in the sentinel node, radiotherapy of the axilla instead of surgery provides excellent regional control. Axillary radiotherapy reduces the risk of short term and long-term compared to axillary .

Explore further: Breast cancer patients with positive ultrasound guided axillary node biopsy need dissection

Related Stories

Breast cancer patients with positive ultrasound guided axillary node biopsy need dissection

May 3, 2012
Contrary to a trend in treatment, breast cancer patients with suspicious lymph nodes should have an ultrasound-guided axillary node biopsy, and if that biopsy is positive these patients should undergo an axillary dissection, ...

Minimally invasive lymph node dissection in breast cancer has advantages over conventional surgery

November 9, 2012
Axillary lymph node dissection is done in conjunction with lumpectomy or mastectomy to determine if breast cancer has spread to the adjoining lymph nodes. The conventional surgical approach leaves a surgical scar that is ...

Less invasive surgery detects residual breast cancer in lymph nodes after chemotherapy

December 5, 2012
Most patients whose breast cancer has spread to their lymph nodes have most of the lymph nodes in their armpit area removed after chemotherapy to see if any cancer remains. A study conducted through the American College of ...

Pretreatment PET/CT imaging of lymph nodes predicts recurrence in breast cancer patients

September 4, 2012
Disease-free survival for invasive ductal breast cancer (IDC) patients may be easier to predict with the help of F-18-fludeoxyglucose positron emission tomography (PET)/computed tomography (CT) scans, according to research ...

Racial disparities still seen in use of breast cancer treatments

December 5, 2012
(HealthDay)—Black women with breast cancer are less likely than their white peers to benefit from improved surgical techniques used to treat their disease, according to a new study.

Recommended for you

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.