ART preferred to ALND in early breast cancer with a positive sentinel lymph node

According to the researchers, axillary radiation therapy (ART) is “preferred” over axillary lymph node dissection (ALND) in patients with early breast cancer with sentinel lymph node (SN).

Ten-year follow-up data from the AMAROS trial showed that locoregional control and survival outcomes were similar with ART and ALND.

The researchers considered ART to be the preferred treatment due to a lower likelihood of lymphedema. However, second cancers were more likely after ART than after ALND.


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These findings were published in the Journal of Clinical Oncology.

The Phase 3 trial (ClinicalTrials.gov Identifier: NCT00014612) included 1,425 patients with cT1-2 node-negative breast cancer with a positive SN biopsy. They were randomly assigned to ALND (n=744) or ART (n=681). Baseline characteristics were well balanced between treatment arms.

The median follow-up was 10 years. The cumulative axillary recurrence rate at 10 years was 0.93% in the ALND arm and 1.82% in the ART arm (relative risk [HR], 1.71; 95% CI, 0.67-4.39).

The 10-year disease-free survival rate was 75.0% in the ALND arm and 70.1% in the ART arm (HR, 1.19; 95% CI, 0.97-1.46; P =.11). The 10-year overall survival rate was 84.6% and 81.4%, respectively (HR, 1.17; 95% CI, 0.89-1.52; P =.26).

In an updated 5-year analysis, the rate of lymphedema was 24.5% after ALND and 11.9% after ART (P <.001 the incidence of lymphedema reported at any time during follow-up was after alnd and art.>

In an exploratory analysis, the 10-year cumulative incidence of locoregional recurrences was 3.6% after ALND and 4.1% after ART (HR, 1.13; 95% CI, 0.65-1.20 ; P =.69).

The 10-year cumulative incidence of second primary cancer was 12.1% in the ART arm and 8.3% in the ALND arm (HR, 1.45; 95% CI, 1.03 to 2.04 ; P =.035).

“Although a slightly higher number of second primary cancers were observed after ART, the 10-year results of the AMAROS trial confirm excellent long-term local and regional control and low morbidity after ART for patients with early breast cancer and a positive SN biopsy,” the researchers concluded. “Given less arm morbidity, ART is preferred over ALND for patients with cT1 breast cancer. -2 SN-positive.”

“[A]xillary dissection should be limited to patients with severe nodal disease,” wrote Kathy D. Miller, MD, the journal’s associate editor, in a commentary. “For those with lymph node-limited disease, the real question is whether axillary therapy is needed.”

Disclosures: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Bartels SAL, Donker M, Poncet C, et al. Armpit radiotherapy or surgery after a positive sentinel lymph node in breast cancer: 10-year results from the randomized controlled trial EORTC 10981-22023 AMAROS. J Clin Oncol. Published online November 16, 2022. doi:10.1200/JCO.22.01565

Christopher S. Washington