The standard of care for evaluating the axilla in breast cancer is sentinel lymph node biopsy. For patients who happen to have positive lymph node involvement by sentinel lymph node biopsy, additional treatment of the axilla is necessary. Proceeding with total axillary lymph node dissection (ALND)while effective is associated with significant morbidity and may not be needed in all patients with positive sentinel lymph node biopsy. The AMAROS trial came to provide a needed answer, ” Can axillary radiation therapy to the axilla in a specific subset of patients with positive sentinel lymph node be done in place of ALND?”
Patients with T1-T2 tumors
and Non plapable Lymph nodes
should be considerd for
if Sentinel LN is positive
In this multi-institution trial, between 2001 and 2010 a total of 4823 patients were enrolled and randomized to either receive ALND or axillary radiation, only 1425 patients were found to have positive sentinel lymph nodes, 744 went to have ALND, 681 went to have axillary radiation.
Results and Conclusion: the AMAROS trial demonstrated that in patients with T1 or T2 tumors and nonpalpable lymph nodes proceeding with sentinel lymph node biopsy and adding axillary radiation therapy for patients with positive lymph nodes showed no statistically significant difference with regard to disease free survival, overall survival and axillary recurrence, furthermore, the patient who had axillary radiation had significantly less incidence of lymphedema.
Comments: I find the results of this trial as welcome addition to the current practice and obviate the need for ALND for specific patients population who do not fit the criteria of Z0011 trial. To translate the AMAROS trial to the clinic, one must consider the exact patient population of the trial i.e. T1-T2 tumors with no palpable lymph node, and also use the same exact radiation therapy timing and technique utilized in the trial.
For more detailed and comprehensive presentation about the AMAROS trial please click here.