Friday, August 9, 2024

Avoidance of axillary dissection

 

  • If SLNB is neg, ALND offers no OS benefit (ACOSOG Z 10, MILAN, B32)
  • In clinically node neg T1 T2 no neoadjuvant chemo and no CI to WBRT, if 1-2 SLNB positive, no need to do full ALND ( ACOSOG Z11- excluded mastectomy).
  • In patients undergoing mastectomy, if microscopic SLN+, no need for full ALND
  • In T1/T2 cN0, if SLN+, Axillary RT better than ALND in terms of morbidity, no difference in OS or regional failure ( AMAROS, also had 17% mastectomy)
  • OTOASAR trial similar to AMAROS but included pt with T < 3 cm, cN0, 1-2 SLN+, similar outcomes ie axillary RT non inferior to ALND


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