The effect of omitting axillary dissection and the impact of radiotherapy on patients with breast cancer sentinel node macrometastases: a cohort study following the ACOSOG Z0011 and AMAROS trials.

Axilla Breast Neoplasms / radiotherapy Cohort Studies Dissection Female Humans Lymph Node Excision Mastectomy Retrospective Studies Sentinel Lymph Node Sentinel Lymph Node Biopsy

Axillary recurrences Breast cancer survival Disease-free survival Lymphedema Shoulder motion limitation

Journal

Breast cancer research and treatment

ISSN: 1573-7217

Titre abrégé: Breast Cancer Res Treat

Pays: Netherlands

ID NLM: 8111104

Informations de publication

Date de publication:
Aug 2021

Historique:

received: 14 03 2021

accepted: 25 05 2021

pubmed: 6 6 2021

medline: 28 7 2021

entrez: 5 6 2021

Statut: ppublish

Résumé

To report the outcomes of implementing the ACOSOG Z0011 and AMAROS trials relevant to clinical practice, and to define target groups in whom to avoid or recommend axillary radiotherapy (ART). We also aimed to analyse the reduction in morbidity when axillary lymph node dissection (ALND) was omitted. A retrospective cohort study of T1-T2 patients with macrometastases at sentinel lymph node (SLN) who were treated between 2011 and 2020. Breast surgery included either lumpectomy or mastectomy. Patients with ≤ 2 positive SLN were divided into two cohorts by whether they received ART or not. Survival outcomes and morbidity were analysed by Kaplan-Meyer curves and Cox-regression, respectively. 260 pN1a patients were included and ALND was avoided in 167 (64.2%). According the Z0011 results, 72 (43.1%) received no further ART; and based on AMAROS criteria 95 (56.9%) received ART. Median follow-up was 54 months. The 5-year overall survival was 96.8% in the non-RT cohort and 93.4% in the RT cohort (p = 0.19), while the respective 5-year disease-free survivals were 100% and 92.3% (p = 1.06). Lymphedema developed in 3.6% of patients after SLNB versus 43% after ALND (OR 20.25; 95%CI 8.13-50.43). Decreased upper-extremity range of motion appeared in 8.4% of patients after SLNB versus 31.2% after ALND (OR 4.95; 95%CI 2.45-9.98%). Our study confirms that omitting ALND is safe and has high survival rates in patients with T1-T2 tumours and ≤ 2 positive SLNs. Adding ART could be a treatment option for patients who present other risk factors. Avoiding ALND with or without ART was associated with significantly less arm morbidity.

Identifiants

DOI: 10.1007/s10549-021-06274-9 PMID: 34089119

pubmed: 34089119

doi: 10.1007/s10549-021-06274-9

pii: 10.1007/s10549-021-06274-9

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

111-120

Informations de copyright

Références

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