We Can Safely Reduce Armpit Surgery in Early-Stage Breast Cancer

At the 2018 San Antonio Breast Cancer Symposium, the AMAROS study's 10-year results showed that in early-stage breast cancer, for the axilla (armpit), minimal surgery plus radiotherapy would be sufficient and extensive lymph node clearance provided no additional benefit.

In recent years, in breast cancer treatment, excessive surgeryhas been giving way to minimally invasive surgical methods. Surgical techniques used on the breast are becoming less extensive every day; avoiding aggressive surgery is known not to add a risk of recurrence and also to offer advantages in quality of life .

Excessive surgery on lymph nodes in the axillary area, known as the armpit, leads to undesirable conditions such as restricted shoulder movement, an increased risk of lymphedema and impaired quality of life. Such extensive operations have been performed to date to minimize the risk of disease recurrence. However, studies now show that this approach should be abandoned.

Details of the Phase-3 Clinical Trial Called AMAROS

The study included patients with clinically node-negative breast cancer (no cancer detected in the armpit on examination or oncological imaging ), totaling 4806 patients. Subsequently, in 1425 patients, axillary sentinel (guard) lymph node biopsy was positive for cancer, and the study continued with this subgroup. Patients were then randomly assigned to 2 arms; 744 underwent axillary lymph node dissection (extensive armpit surgery), and 681 received axillary radiotherapy .

Study Results After 10 years;

• Among those receiving axillary radiotherapy, % 1.8 (of 681 patients, 11) and among those undergoing axillary lymph node dissection, % 0.9 (of 744 patients, 7) had, in the armpit area, cancer recurrence detected.
• In addition, distant metastasis-free survival and overall survival, between the two treatment arms, did not differ. Distant metastasis-free survival was % 78.2 among those receiving axillary radiotherapy and % 81.7 in the axillary lymph node dissection group; overall survival in the two arms was % 81.4 and % 84.6, respectively.
• Secondary breast cancer occurred more often in patients receiving radiotherapy than in those undergoing extensive armpit surgery (% 11 versus % 7.7). This difference was thought mainly to be attributable to the limited targeted irradiation capabilities of older radiotherapy devices and unintended radiation to the opposite breast. Modern radiotherapy techniques are expected to eliminate this unexpected outcome or make it less frequent.

In conclusion, radiotherapy to the axillary area appears, in this patient group, to be an option as effective as extensive lymph node clearance while causing fewer adverse effects.