Andres Rodriguez Mignola: Axillary Lymph Node Dissection versus Radiotherapy – Were AMAROS and ACOSOG Z011 Correct?
Andres Rodriguez Mignola, Radiation Oncologist at
“Axillary Lymph Node Dissection versus Radiotherapy: Were AMAROS and ACOSOG Z011 Correct?
In the last 15 years, numerous studies have been published on the non-inferiority of axillary or breast radiotherapy compared to axillary lymph node dissection in T1-T2 cN0 patients with up to 2 macrometastatic nodes (ACOSOG Z0011, AMAROS, OTOASOR, SINODAR-ONE), with the standard of care in many centers being the omission of lymph node dissection in these patients.
A point of contention in some of these studies is the treatment volume. For instance, in ACOSOG Z011, 15% of patients received treatment in the supraclavicular region, and many of them received therapeutic doses in level I axilla, prompting a recommendation for radiotherapy in the breast with high tangents.
In this noninferiority trial, 2540 randomized patients were allocated into 2 groups: 1335 underwent sentinel lymph node biopsy only, and 1205 underwent lymph node dissection.
Interesting data:
- Median follow-up: 46.8 months
- Included: T3 patients (T1 to T3 breast cancer) with 1 or 2 sentinel-node macrometastases (metastasis size >2 mm in the largest dimension)
- Axillary ultrasound was included in the examination (as opposed to physical examination in previous studies)
- 36% underwent mastectomy (better representation than in AMAROS)
- Triple Negative: 4%
- ECE (extracapsular extension): 33%
- 10% of patients in the lymph node dissection arm had more than 4 nodes (indicating radiotherapy despite lymphadenectomy)
- 90% of patients underwent Nodal Radiotherapy
- No information on lymphedema is available.
Results:
- The estimated 5-year recurrence-free survival was 89.7% in the sentinel-node biopsy–only group and 88.7% in the dissection group.
- The estimated 5-year recurrence-free survival (based on 180 patients – 7.1%) was 89.7% in the sentinel-node biopsy–only group and 88.7% in the dissection group (95% CI, 86.3 to 91.1) in the dissection group.
Conclusion:
The omission of completion axillary lymph node dissection was non inferior to the more extensive surgery in patients with clinically node-negative breast cancer who had sentinel-node macrometastases, most of whom received nodal radiation therapy.”
Link to article.
Source: Andres Rodriguez Mignola/LinkedIn
About OncoDaily
OncoDaily was founded in 2023. It is a US-based oncology media platform, which features the latest news, insights, and patient stories from the world of oncology. Within a short period of time it became one of the leading oncology media platforms globally.
OncoDaily gathers content from various sources, including social media posts from renowned oncologists from all over the world, news from oncology societies and cancer centers, patient and survivor stories, and career-related information for professionals.
The mission of OncoDaily is to empower patients, survivors, and professionals with the knowledge and inspiration they need to fight cancer. The motto of OncoDaily is “Cancer doesn’t take a day off – neither do we”.
