The AMAROS trial compared completion axillary lymph node dissection (ALND) and axillary radiation (ART) in patients with sentinel lymph node positive, pT1-2 breast cancer. Recall that 4806 patients were enrolled and randomized before surgery. Of those, 1425 (30%) had sentinel lymph node metastases and went on to receive either ALND or ART to the axilla and supraclavicular fossa. Also recall that in the ALND arm, 33% had additional lymph node metastases. In this updated analysis, the rate of axillary recurrence at 10 years was similar between arms (0.9% ALND v 1.8% ART). There were no differences in survival outcomes. ALND doubled the rate of lymphedema at 5 years (25% v 12%). ART did not significantly increase the risk of second primary cancer at 10 years (12% v 8%).
- Bartels, J Clin Oncol 2022