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
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