title: Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy.
abstract: BACKGROUND
  The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection.
  
  
  METHODS
  From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT.
  
  
  RESULTS
  After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms.
  
  
  CONCLUSIONS
  This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.
authors.affiliation: Division of Senology, European Institute of Oncology, Via G. Ripamonti 435, 20141 Milan, Italy. umberto.veronesi@ieo.it
authors.forename: U
authors.initials: U
authors.lastname: Veronesi
authors.forename: R
authors.initials: R
authors.lastname: Orecchia
authors.forename: S
authors.initials: S
authors.lastname: Zurrida
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: P
authors.initials: P
authors.lastname: Veronesi
authors.forename: G
authors.initials: G
authors.lastname: Gatti
authors.forename: G
authors.initials: G
authors.lastname: D'Aiuto
authors.forename: L
authors.initials: L
authors.lastname: Cataliotti
authors.forename: R
authors.initials: R
authors.lastname: Paolucci
authors.forename: P
authors.initials: P
authors.lastname: Piccolo
authors.forename: N
authors.initials: N
authors.lastname: Massaioli
authors.forename: P
authors.initials: P
authors.lastname: Sismondi
authors.forename: A
authors.initials: A
authors.lastname: Rulli
authors.forename: F
authors.initials: F
authors.lastname: Lo Sardo
authors.forename: A
authors.initials: A
authors.lastname: Recalcati
authors.forename: D
authors.initials: D
authors.lastname: Terribile
authors.forename: A
authors.initials: A
authors.lastname: Acerbi
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.forename: P
authors.initials: P
authors.lastname: Maisonneuve
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D016896:Treatment Outcome