Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR trial

Sávolt, Ákos; Musonda, Patrick; Mátrai, Zoltán; Polgár, Csaba; Rényi-Vámos, F; Rubovszky, Gábor; Kovács, Eszter; Sinkovics, István; Udvarhelyi, Nóra; Török, Klára; Kásler, Miklós; Péley, Gábor

doi:10.1556/oh.2013.29765

Cited by 27 publications

(23 citation statements)

References 21 publications

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“…Therefore we suggest that axillary radiation may be another choice of axillary treatment in terms of survival. This result was consistent with each trial included in our study 14 15 16 20 . But only one different conclusion was presented in the 5-years outcomes of a randomized study by Paris et al .…”

Section: Discussionsupporting

confidence: 91%

“…The patients‘ characteristics are well balanced between the two groups. Although NSABP B-04 which started patient entry in 1971 was considered an older study, and its treatments seem inappropriate today, it provides long-term results after 25 years of follow-up, while the follow-up time in the AMAROS and OTASOR studies as currently reported are no more than 5 years 16 20 . Characteristics of the included studies are listed in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

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Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

Zhang

Wang

2016

Sci Rep

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Axillary lymph node dissection is standard management of axilla in invasive breast cancer. Radiotherapy also is important in local treatment. It is controversial as to whether axillary radiotherapy can displace axillary lymph node dissection. We performed a meta-analysis comparing axillary radiotherapy with axillary dissection. No significant difference was observed for disease free survival and overall survival between the radiation group and the dissection group. There was also no significant difference in either the axillary recurrence or the local recurrence between the two groups. But the axillary relapse rate in the radiation group was higher than in the surgery group at five-year follow-up while the local recurrence rate in the surgery group was higher than in the radiation group. A subgroup analysis showed that the difference in the axillary recurrence rate (RR = 0.20, P = 0.01) and local recurrence rate (RR = 4.7, P = 0.01) mainly appeared in the clinical node-positive subgroup. The edema rate in the surgery group was higher than in the radiation group (RR = 2.08, 95%: 1.71–2.54, P < 0.0001). We concluded that radiotherapy may be an alternative treatment option for adjuvant management of the axilla in selected sub-groups of patients.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

Zhang

Wang

2016

Sci Rep

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“…Of these, 5 trials reported in 13 publications met the inclusion criteria, two studies were still ongoing (comparing ALND to SLNB [NCT01796444 (Wang 2013 ), and ALND or axillary radiotherapy [aRT] + adjuvant treatment versus adjuvant treatment alone [POSNOC (Goyal 2014a , b )], respectively) while the remaining 147 records were excluded because they were: not a randomised trial (n = 20), ineligible population (n = 101), unclear intervention (n = 2) and ineligible intervention (n = 24); See also Additional file 2 ). The five included studies compared ALND with sentinel lymph node dissection (SLND) to SLND alone [ACOSOG Z0011 (Lucci et al 2007 ; Olsen and McCall 2008 ; Giuliano et al 2010 , 2011 ); ATTRM-048-13-2000 (Sola et al 2013 ); IBCSG-23-01 (Galimberti et al 2011 , 2012 , 2013 )], and ALND to aRT [AMAROS (Straver et al 2010a , b ; Donker et al 2014 ); OTOASOR (Savolt et al 2013a , b )]. See Tables 1 and 2 for summary study details and risk-of-bias levels, respectively, and Additional file 3 for full study details and risk-of-bias assessments.…”

Section: Resultsmentioning

confidence: 99%

Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses

Schmidt‐Hansen¹,

Bromham²,

Hasler³

et al. 2016

SpringerPlus

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Traditionally, women with node-positive operable breast cancer have received complete axillary lymph node dissection (ALND), which is associated with significant morbidity, but recently less invasive alternatives have been explored. We conducted a systematic review of randomised controlled trials assessing alternative approaches to axillary surgery in patients with pathologically-confirmed sentinel node-positive operable breast cancer. We searched on 16/3/15 the Specialized Register of the Cochrane Breast Cancer group; CENTRAL; MEDLINE; PreMEDLINE; EMBASE; WHO International Clinical Trials Registry Portal; ClinicalTrials.gov; conference proceedings from ASCO and the San Antonio Breast Cancer meetings; checked reference lists and contacted authors to identify relevant studies. Double, independent study sifting, extraction, appraisal and summarising were undertaken using standard Cochrane Collaboration methodology. We included three studies (2020 patients) comparing ALND with sentinel lymph node dissection (SLND) to SLND alone, and two studies (1899 patients) comparing ALND to axillary radiotherapy (aRT). No differences in survival or recurrence were observed between ALND and SLND or aRT, but morbidity may have been increased in ALND, and all the results were subject to different biases, such as recruitment bias, performance bias, and outcome-reporting bias. Whilst it is encouraging that there appears to be no adverse effect on recurrence or survival, it will be appropriate to confirm these findings and provide additional data confirming quality of life effects and long term outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-1712-9) contains supplementary material, which is available to authorized users.

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“…The AMAROS [13] and OTOSAR trials [14] examined the use of axillary RT as an alternative to ALND and observed no differences in survival or axillary recurrence rates between treatments, and the AMAROS study [13] reported a lower rate of lymphedema in the axillary RT group. These studies raise the possibility that ALND could be avoided in patients undergoing mastectomy if the need for postmastectomy RT was clear based on the finding of metastases in 1 or 2 sentinel nodes, but do not answer the question of whether or not RT is necessary in all patients undergoing sentinel node biopsy alone as in the ACOSOG ZO11 trial.…”

Section: Alternatives To Axillary Dissectionmentioning

confidence: 99%

Progress in the surgical management of breast cancer: Present and future

Morrow

2015

The Breast

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Recognition of differing risks of locoregional recurrence (LRR) in breast cancer patients based on estrogen receptor, progesterone receptor, and HER2 status, coupled with a reduction in LRR in patients receiving adjuvant systemic therapy, offers the opportunity to tailor surgical treatment and reduce the morbidity of therapy. New guidelines for margins in breast-conserving therapy of tumor not touching ink and avoidance of axillary dissection in sentinel node positive patients undergoing breast-conserving therapy are examples of this approach which have entered practice. Increased use of neoadjuvant therapy offers the opportunity to identify which patients are responsive to chemotherapy prior to surgery, potentially allowing further tailoring of treatment, and ongoing clinical trials will address the question of the extent of axillary surgery and radiotherapy after neoadjuvant therapy in patients with and without pathologic complete response.

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Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR trial

Abstract: The authors conclude that after a mean follow-up of more than 40 months axillary nodal irradiation may control the disease in the axilla as effectively as completion axillary lymph node dissection and there was also no difference in terms of overall survival.

Cited by 27 publications

References 21 publications

Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses

Progress in the surgical management of breast cancer: Present and future

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