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Annals of Surgical Oncology

, Volume 25, Issue 9, pp 2612–2619 | Cite as

The Potential Impact of AMAROS on the Management of the Axilla in Patients with Clinical T1-2N0 Breast Cancer Undergoing Primary Total Mastectomy

  • Martine Moossdorff
  • Faina Nakhlis
  • Jiani Hu
  • William T. Barry
  • Katya Losk
  • Courtney Haskett
  • Marjolein L. Smidt
  • Tari A. KingEmail author
Breast Oncology

Abstract

Background

Recent trials have demonstrated that axillary observation or axillary radiation therapy (AxRT) is equivalent to axillary node dissection (ALND) for patients with one or two positive sentinel lymph nodes (SLNs). These strategies have been widely adopted for patients having breast conservation. This report demonstrates the potential impact of the AMAROS trial on axillary therapy in a retrospective cohort of mastectomy patients.

Methods

Patients undergoing primary mastectomy for cT1-2N0 breast cancer who had one or two positive SLNs were identified from institutional databases (2005–2015). Locoregional management strategies were evaluated, and variables predictive of the use of postmastectomy radiation therapy (PMRT) were identified.

Results

Among 2594 mastectomies, 193 (7%) met the AMAROS eligibility criteria. The median patient age was 50 years (range 22–83 years). Locoregional treatment consisted of ALND + PMRT for 102 patients (53%), ALND alone for 66 patients (34%), PMRT alone for 11 patients (6%), and observation for 14 patients (7%). Overall, 59 ALND patients (35%) had additional positive nodes. In the multivariate analysis, age younger than 50 years (odds ratio [OR] 3.55; 95% confidence interval [CI] 1.57–8.45), lymphovascular invasion (LVI) (OR 5.78; 95% CI 2.53–4.78), macrometastases (OR 3.99; 95% CI 1.54–10.97), and extracapsular extension (OR 11.66; 95% CI 2.55–88.34) were associated with receipt of PMRT.

Conclusion

In this cohort of AMAROS-eligible patients, 168 (87%) underwent ALND, 102 (61%) of whom also received PMRT, suggesting that AxRT could have been used instead of ALND for a significant number of patients. Preoperative factors associated with the receipt of PMRT, such as young age and LVI, may be useful for defining a multidisciplinary decision-making framework for axillary management in this population.

Notes

Acknowledgment

William T. Barry reports research funding (institutional) from Pfizer.

Supplementary material

10434_2018_6519_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Martine Moossdorff
    • 1
  • Faina Nakhlis
    • 2
    • 3
  • Jiani Hu
    • 4
  • William T. Barry
    • 4
  • Katya Losk
    • 5
  • Courtney Haskett
    • 2
  • Marjolein L. Smidt
    • 1
  • Tari A. King
    • 2
    • 3
    Email author
  1. 1.Department of Surgery, GROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Dana-Farber/Brigham and Women’s Cancer CenterBostonUSA
  4. 4.Department of Biostatistics and Computational BiologyDana-Farber Cancer InstituteBostonUSA
  5. 5.Medical OncologyDana-Farber Cancer InstituteBostonUSA

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