Eight-year follow up results of the OTOASOR trial: The optimal treatment of the axilla – surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer. A randomized, single centre, phase III, non-inferiority trial

Sávolt, Ákos; Péley, Gábor; Polgár, Csaba; Győrffy, Balázs; Mátrai, Zoltán

doi:10.1093/annonc/mdx362.016

Cited by 13 publications

(15 citation statements)

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“…In the present study of patients with breast cancer who had axillary LNMs detected before surgery, one‐third had only one or two positive nodes in the completion ALND specimen. These patients with a limited axillary disease burden do not necessarily benefit from further axillary surgery, and could be treated with adjuvant radiotherapy and systemic treatment, in agreement with studies of clinically node‐negative breast cancer. The AMAROS and OTOASOR (Optimal Treatment Of the Axilla – Surgery Or Radiotherapy) trials included patients who had breast conservation or mastectomy, although the mastectomy rate was higher in the present study.…”

Section: Discussionsupporting

confidence: 66%

Axillary nodal metastatic burden in patients with breast cancer with clinically positive axillary nodes

Niinikoski

Hukkinen

Leidenius

et al. 2020

British Journal of Surgery

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Background: The aim of this study was to determine preoperative factors and tumour characteristics related to a high nodal tumour burden in patients with clinically node-positive breast cancer. These findings were used to construct a predictive tool to evaluate the patient-specific risk of having more than two axillary lymph node metastases. Methods: Altogether, 507 consecutive patients with breast cancer and axillary lymph node metastasis diagnosed by preoperative ultrasound-guided needle biopsy were reviewed. These patients underwent breast surgery and axillary lymph node dissection at Helsinki University Hospital between 2010 and 2014. Patients were grouped into those with one or two, and those with more than two lymph node metastases. Results: There were 153 patients (30⋅2 per cent) with one or two lymph node metastases and 354 (69⋅8 per cent) with more than two metastases. Five-year disease-free survival was poorer for the latter group (P = 0⋅032). Five-year overall survival estimates for patients with one or two and those with more than two lymph node metastases were 87⋅0 and 81⋅4 per cent respectively (P = 0⋅215). In multivariable analysis, factors significantly associated with more than two lymph node metastases were: age, tumour size, lymphovascular invasion in the primary tumour, extracapsular extension of metastasis in lymph nodes, and morphology of lymph nodes. These factors were included in a multivariable predictive model, which had an area under the curve of 0⋅828 (95 per cent c.i. 0⋅787 to 0⋅869). Conclusion: The present study provides a patient-specific prediction model for evaluating nodal tumour burden in patients with clinically node-positive breast cancer.

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Section: Discussionsupporting

confidence: 66%

Axillary nodal metastatic burden in patients with breast cancer with clinically positive axillary nodes

Niinikoski

Hukkinen

Leidenius

et al. 2020

British Journal of Surgery

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“…The monocentric OTOASOR trial ( O ptimal T reatment O f the A xilla-S urgery O r R adiotherapy) confirmed the AMAROS findings. Among 2,073 patients with early breast cancer and low SLNB burden, axillary nodal irradiation was noninferior to completion ALND in terms of survival and regional recurrence [28] .…”

Section: Macrometastatic Slnmentioning

confidence: 99%

Axillary surgery in breast cancer: An updated historical perspective

Magnoni

Galimberti

Corso

et al. 2020

Seminars in Oncology

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This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing effort s of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymphnode biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.

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“…Data from recent studies 1‐5 indicate that in patients with early‐stage breast cancer and limited sentinel node metastasis, SLND/RT only instead of ALND may be an acceptable alternative, with lower rate of lymphedema, seroma, pain, and sensory changes. The ACOSOG Z0011 trial suggested that the patients who received breast‐conserving surgery (BCS), whole breast radiotherapy, and adjuvant systemic treatment may avoid ALND if only one or two sentinel lymph nodes were positive, without compromising local recurrence or overall survival.…”

Section: Introductionmentioning

confidence: 99%

Axillary lymph node dissection vs sentinel biopsy only among women with early‐stage breast cancer and sentinel node metastasis: A systematic review and meta‐analysis

Peristeri

Harissis

2020

Breast J

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Axillary lymph node dissection (ALND) in early‐stage breast cancer with limited sentinel node metastasis may not be superior to sentinel lymph node dissection (SLND). We performed a meta‐analysis comparing SLND/Radiotherapy (RT) with ALND. All data were analyzed using Review Manager Software 5.3. Five randomized controlled trials (RCTs) were included. Overall survival, death, and disease‐free survival were estimated higher in the SLND group compared to the ALND group. Statistically significant differences in axillary recurrence were observed in favor of ALND. Omission of ALND in patients with <3 positive SLNs is indicated.

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Eight-year follow up results of the OTOASOR trial: The optimal treatment of the axilla – surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer. A randomized, single centre, phase III, non-inferiority trial

Cited by 13 publications

References 0 publications

Axillary nodal metastatic burden in patients with breast cancer with clinically positive axillary nodes

Axillary nodal metastatic burden in patients with breast cancer with clinically positive axillary nodes

Axillary surgery in breast cancer: An updated historical perspective

Axillary lymph node dissection vs sentinel biopsy only among women with early‐stage breast cancer and sentinel node metastasis: A systematic review and meta‐analysis

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