Avoiding axillary dissection in breast cancer surgery: A randomized trial to assess the role of axillary radiotherapy

Umberto Veronesi, R. Orecchia, S. Zurrida, V. Galimberti, A. Luini, P. Veronesi, G. Gatti, G. D'Aiuto, L. Cataliotti, R. Paolucci, P. Piccolo, N. Massaioli, P. Sismondi, A. Rulli, F. Lo Sardo, A. Recelcati, D. Terribile, A. Acerbi, N. Rotmensz, P. MaisonneuveF. Nolè, M. Aapro, M. Rinaldo, P. Frezza, L. Orzalesi, R. Simoncini, M. P. Mano, R. Bordon, C. Cosuccia, M. Sacco, M. Donadio, A. R. Vento, P. Latini, M. Fumagalli, G. Finzi, C. Lo Castro, L. Tardone, G. Ausili, M. Limonta, M. Colombo, P. Lotta, B. Agostara, S. Modena, B. Carrara, M. Romano

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Background: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. Patients and methods: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. Results: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. Conclusions: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.

Original languageEnglish
Pages (from-to)383-388
Number of pages6
JournalAnnals of Oncology
Volume16
Issue number3
DOIs
Publication statusPublished - Mar 2005

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Dissection
Radiotherapy
Breast Neoplasms
Neoplasm Metastasis
Axilla
Breast
Disease-Free Survival
Arm
Therapeutics
Confidence Intervals
Carcinoma
Recurrence

Keywords

  • Axillary radiotherapy
  • Breast cancer
  • Lymph nodes
  • Metastases
  • Randomized trial

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Avoiding axillary dissection in breast cancer surgery : A randomized trial to assess the role of axillary radiotherapy. / Veronesi, Umberto; Orecchia, R.; Zurrida, S.; Galimberti, V.; Luini, A.; Veronesi, P.; Gatti, G.; D'Aiuto, G.; Cataliotti, L.; Paolucci, R.; Piccolo, P.; Massaioli, N.; Sismondi, P.; Rulli, A.; Lo Sardo, F.; Recelcati, A.; Terribile, D.; Acerbi, A.; Rotmensz, N.; Maisonneuve, P.; Nolè, F.; Aapro, M.; Rinaldo, M.; Frezza, P.; Orzalesi, L.; Simoncini, R.; Mano, M. P.; Bordon, R.; Cosuccia, C.; Sacco, M.; Donadio, M.; Vento, A. R.; Latini, P.; Fumagalli, M.; Finzi, G.; Lo Castro, C.; Tardone, L.; Ausili, G.; Limonta, M.; Colombo, M.; Lotta, P.; Agostara, B.; Modena, S.; Carrara, B.; Romano, M.

In: Annals of Oncology, Vol. 16, No. 3, 03.2005, p. 383-388.

Research output: Contribution to journalArticle

Veronesi, U, Orecchia, R, Zurrida, S, Galimberti, V, Luini, A, Veronesi, P, Gatti, G, D'Aiuto, G, Cataliotti, L, Paolucci, R, Piccolo, P, Massaioli, N, Sismondi, P, Rulli, A, Lo Sardo, F, Recelcati, A, Terribile, D, Acerbi, A, Rotmensz, N, Maisonneuve, P, Nolè, F, Aapro, M, Rinaldo, M, Frezza, P, Orzalesi, L, Simoncini, R, Mano, MP, Bordon, R, Cosuccia, C, Sacco, M, Donadio, M, Vento, AR, Latini, P, Fumagalli, M, Finzi, G, Lo Castro, C, Tardone, L, Ausili, G, Limonta, M, Colombo, M, Lotta, P, Agostara, B, Modena, S, Carrara, B & Romano, M 2005, 'Avoiding axillary dissection in breast cancer surgery: A randomized trial to assess the role of axillary radiotherapy', Annals of Oncology, vol. 16, no. 3, pp. 383-388. https://doi.org/10.1093/annonc/mdi089
Veronesi, Umberto ; Orecchia, R. ; Zurrida, S. ; Galimberti, V. ; Luini, A. ; Veronesi, P. ; Gatti, G. ; D'Aiuto, G. ; Cataliotti, L. ; Paolucci, R. ; Piccolo, P. ; Massaioli, N. ; Sismondi, P. ; Rulli, A. ; Lo Sardo, F. ; Recelcati, A. ; Terribile, D. ; Acerbi, A. ; Rotmensz, N. ; Maisonneuve, P. ; Nolè, F. ; Aapro, M. ; Rinaldo, M. ; Frezza, P. ; Orzalesi, L. ; Simoncini, R. ; Mano, M. P. ; Bordon, R. ; Cosuccia, C. ; Sacco, M. ; Donadio, M. ; Vento, A. R. ; Latini, P. ; Fumagalli, M. ; Finzi, G. ; Lo Castro, C. ; Tardone, L. ; Ausili, G. ; Limonta, M. ; Colombo, M. ; Lotta, P. ; Agostara, B. ; Modena, S. ; Carrara, B. ; Romano, M. / Avoiding axillary dissection in breast cancer surgery : A randomized trial to assess the role of axillary radiotherapy. In: Annals of Oncology. 2005 ; Vol. 16, No. 3. pp. 383-388.
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title = "Avoiding axillary dissection in breast cancer surgery: A randomized trial to assess the role of axillary radiotherapy",
abstract = "Background: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. Patients and methods: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. Results: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5{\%}) and one in the RT group (0.5{\%}). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0{\%} (95{\%} confidence interval, 94.1{\%}-97.9{\%}) without significant differences between the two arms. Conclusions: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.",
keywords = "Axillary radiotherapy, Breast cancer, Lymph nodes, Metastases, Randomized trial",
author = "Umberto Veronesi and R. Orecchia and S. Zurrida and V. Galimberti and A. Luini and P. Veronesi and G. Gatti and G. D'Aiuto and L. Cataliotti and R. Paolucci and P. Piccolo and N. Massaioli and P. Sismondi and A. Rulli and {Lo Sardo}, F. and A. Recelcati and D. Terribile and A. Acerbi and N. Rotmensz and P. Maisonneuve and F. Nol{\`e} and M. Aapro and M. Rinaldo and P. Frezza and L. Orzalesi and R. Simoncini and Mano, {M. P.} and R. Bordon and C. Cosuccia and M. Sacco and M. Donadio and Vento, {A. R.} and P. Latini and M. Fumagalli and G. Finzi and {Lo Castro}, C. and L. Tardone and G. Ausili and M. Limonta and M. Colombo and P. Lotta and B. Agostara and S. Modena and B. Carrara and M. Romano",
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T1 - Avoiding axillary dissection in breast cancer surgery

T2 - A randomized trial to assess the role of axillary radiotherapy

AU - Veronesi, Umberto

AU - Orecchia, R.

AU - Zurrida, S.

AU - Galimberti, V.

AU - Luini, A.

AU - Veronesi, P.

AU - Gatti, G.

AU - D'Aiuto, G.

AU - Cataliotti, L.

AU - Paolucci, R.

AU - Piccolo, P.

AU - Massaioli, N.

AU - Sismondi, P.

AU - Rulli, A.

AU - Lo Sardo, F.

AU - Recelcati, A.

AU - Terribile, D.

AU - Acerbi, A.

AU - Rotmensz, N.

AU - Maisonneuve, P.

AU - Nolè, F.

AU - Aapro, M.

AU - Rinaldo, M.

AU - Frezza, P.

AU - Orzalesi, L.

AU - Simoncini, R.

AU - Mano, M. P.

AU - Bordon, R.

AU - Cosuccia, C.

AU - Sacco, M.

AU - Donadio, M.

AU - Vento, A. R.

AU - Latini, P.

AU - Fumagalli, M.

AU - Finzi, G.

AU - Lo Castro, C.

AU - Tardone, L.

AU - Ausili, G.

AU - Limonta, M.

AU - Colombo, M.

AU - Lotta, P.

AU - Agostara, B.

AU - Modena, S.

AU - Carrara, B.

AU - Romano, M.

PY - 2005/3

Y1 - 2005/3

N2 - Background: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. Patients and methods: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. Results: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. Conclusions: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.

AB - Background: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. Patients and methods: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. Results: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. Conclusions: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.

KW - Axillary radiotherapy

KW - Breast cancer

KW - Lymph nodes

KW - Metastases

KW - Randomized trial

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