title: Role of axillary clearance after a tumor-positive sentinel node in the administration of adjuvant therapy in early breast cancer.
abstract: PURPOSE The After Mapping of the Axilla: Radiotherapy or Surgery? (AMAROS) phase III study compares axillary lymph node dissection (ALND) and axillary radiation therapy (ART) in early breast cancer patients with tumor-positive sentinel nodes. In the ART arm, the extent of nodal involvement remains unknown, which could have implications on the administration of adjuvant therapy. In this preliminary analysis, we studied the influence of random assignment to ALND or ART on the choice for adjuvant treatment. PATIENTS AND METHODS In the first 2,000 patients enrolled in the AMAROS trial, we analyzed the administration of adjuvant systemic therapy. Multivariate analysis was used to assess variables affecting the administration of adjuvant chemotherapy. Adjuvant therapy was applied according to institutional guidelines. Results Of 2,000 patients, 566 patients had a positive sentinel node and were treated per random assignment. There was no significant difference in the administration of adjuvant systemic therapy. In the ALND and ART arms, 58% (175 of 300) and 61% (162 of 266) of the patients, respectively, received chemotherapy. Endocrine therapy was administered in 78% (235 of 300) of the patients in the ALND arm and in 76% (203 of 266) of the patients in the ART arm. Treatment arm was not a significant factor in the decision, and no interactions between treatment arm and other factors were observed. Multivariate analysis showed that age, tumor grade, multifocality, and size of the sentinel node metastasis significantly affected the administration of chemotherapy. Within the ALND arm, the extent of nodal involvement remained not significant in a sensitivity multivariate analysis. CONCLUSION Absence of knowledge regarding the extent of nodal involvement in the ART arm appears to have no major impact on the administration of adjuvant therapy.
authors.affiliation: The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands.
authors.forename: Marieke E
authors.initials: ME
authors.lastname: Straver
authors.forename: Philip
authors.initials: P
authors.lastname: Meijnen
authors.forename: Geertjan
authors.initials: G
authors.lastname: van Tienhoven
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mansel
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaerts
authors.forename: Gaston
authors.initials: G
authors.lastname: Demonty
authors.forename: Nicole
authors.initials: N
authors.lastname: Duez
authors.forename: Luigi
authors.initials: L
authors.lastname: Cataliotti
authors.forename: Jean
authors.initials: J
authors.lastname: Klinkenbijl
authors.forename: Helen A
authors.initials: HA
authors.lastname: Westenberg
authors.forename: Huub
authors.initials: H
authors.lastname: van der Mijle
authors.forename: Coen
authors.initials: C
authors.lastname: Hurkmans
authors.forename: Emiel J T
authors.initials: EJ
authors.lastname: Rutgers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005060:Europe; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents