Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer
Identifieur interne : 003834 ( Ncbi/Curation ); précédent : 003833; suivant : 003835Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer
Auteurs : Marieke E. Straver [Italie] ; Philip Meijnen [Italie] ; Geertjan Van Tienhoven [Italie] ; Cornelis J. H. Van De Velde [Italie] ; Robert E. Mansel [Italie] ; Jan Bogaerts [Italie] ; Gaston Demonty [Italie] ; Nicole Duez [Italie] ; Luigi Cataliotti [Italie] ; Jean Klinkenbijl [Italie] ; Helen A. Westenberg [Italie] ; Huub Van Der Mijle [Italie] ; Coen Hurkmans [Italie] ; Emiel J. T. Rutgers [Italie]Source :
- Journal of Clinical Oncology [ 0732-183X ] ; 2009.
Abstract
The After Mapping of the Axilla: Radiotherapy or Surgery? (AMAROS) phase III study compares axillary lymph node dissection (ALND) and axillary radiation therapy (ART) in early breast cancer patients with tumor-positive sentinel nodes. In the ART arm, the extent of nodal involvement remains unknown, which could have implications on the administration of adjuvant therapy. In this preliminary analysis, we studied the influence of random assignment to ALND or ART on the choice for adjuvant treatment.
In the first 2,000 patients enrolled in the AMAROS trial, we analyzed the administration of adjuvant systemic therapy. Multivariate analysis was used to assess variables affecting the administration of adjuvant chemotherapy. Adjuvant therapy was applied according to institutional guidelines.
Of 2,000 patients, 566 patients had a positive sentinel node and were treated per random assignment. There was no significant difference in the administration of adjuvant systemic therapy. In the ALND and ART arms, 58% (175 of 300) and 61% (162 of 266) of the patients, respectively, received chemotherapy. Endocrine therapy was administered in 78% (235 of 300) of the patients in the ALND arm and in 76% (203 of 266) of the patients in the ART arm. Treatment arm was not a significant factor in the decision, and no interactions between treatment arm and other factors were observed. Multivariate analysis showed that age, tumor grade, multifocality, and size of the sentinel node metastasis significantly affected the administration of chemotherapy. Within the ALND arm, the extent of nodal involvement remained not significant in a sensitivity multivariate analysis.
Absence of knowledge regarding the extent of nodal involvement in the ART arm appears to have no major impact on the administration of adjuvant therapy.
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DOI: 10.1200/JCO.2008.21.7554
PubMed: 20038733
PubMed Central: 2834391
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer</title><author><name sortKey="Straver, Marieke E" sort="Straver, Marieke E" uniqKey="Straver M" first="Marieke E." last="Straver">Marieke E. Straver</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Meijnen, Philip" sort="Meijnen, Philip" uniqKey="Meijnen P" first="Philip" last="Meijnen">Philip Meijnen</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Van Tienhoven, Geertjan" sort="Van Tienhoven, Geertjan" uniqKey="Van Tienhoven G" first="Geertjan" last="Van Tienhoven">Geertjan Van Tienhoven</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Van De Velde, Cornelis J H" sort="Van De Velde, Cornelis J H" uniqKey="Van De Velde C" first="Cornelis J. H." last="Van De Velde">Cornelis J. H. Van De Velde</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Mansel, Robert E" sort="Mansel, Robert E" uniqKey="Mansel R" first="Robert E." last="Mansel">Robert E. Mansel</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Bogaerts, Jan" sort="Bogaerts, Jan" uniqKey="Bogaerts J" first="Jan" last="Bogaerts">Jan Bogaerts</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Demonty, Gaston" sort="Demonty, Gaston" uniqKey="Demonty G" first="Gaston" last="Demonty">Gaston Demonty</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Duez, Nicole" sort="Duez, Nicole" uniqKey="Duez N" first="Nicole" last="Duez">Nicole Duez</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Cataliotti, Luigi" sort="Cataliotti, Luigi" uniqKey="Cataliotti L" first="Luigi" last="Cataliotti">Luigi Cataliotti</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Klinkenbijl, Jean" sort="Klinkenbijl, Jean" uniqKey="Klinkenbijl J" first="Jean" last="Klinkenbijl">Jean Klinkenbijl</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Westenberg, Helen A" sort="Westenberg, Helen A" uniqKey="Westenberg H" first="Helen A." last="Westenberg">Helen A. Westenberg</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Van Der Mijle, Huub" sort="Van Der Mijle, Huub" uniqKey="Van Der Mijle H" first="Huub" last="Van Der Mijle">Huub Van Der Mijle</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Hurkmans, Coen" sort="Hurkmans, Coen" uniqKey="Hurkmans C" first="Coen" last="Hurkmans">Coen Hurkmans</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Rutgers, Emiel J T" sort="Rutgers, Emiel J T" uniqKey="Rutgers E" first="Emiel J. T." last="Rutgers">Emiel J. T. Rutgers</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20038733</idno><idno type="pmc">2834391</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834391</idno><idno type="RBID">PMC:2834391</idno><idno type="doi">10.1200/JCO.2008.21.7554</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">002F36</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F36</idno><idno type="wicri:Area/Pmc/Curation">002F35</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002F35</idno><idno type="wicri:Area/Pmc/Checkpoint">003601</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003601</idno><idno type="wicri:Area/Ncbi/Merge">003834</idno><idno type="wicri:Area/Ncbi/Curation">003834</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer</title><author><name sortKey="Straver, Marieke E" sort="Straver, Marieke E" uniqKey="Straver M" first="Marieke E." last="Straver">Marieke E. Straver</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Meijnen, Philip" sort="Meijnen, Philip" uniqKey="Meijnen P" first="Philip" last="Meijnen">Philip Meijnen</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Van Tienhoven, Geertjan" sort="Van Tienhoven, Geertjan" uniqKey="Van Tienhoven G" first="Geertjan" last="Van Tienhoven">Geertjan Van Tienhoven</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Van De Velde, Cornelis J H" sort="Van De Velde, Cornelis J H" uniqKey="Van De Velde C" first="Cornelis J. H." last="Van De Velde">Cornelis J. H. Van De Velde</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Mansel, Robert E" sort="Mansel, Robert E" uniqKey="Mansel R" first="Robert E." last="Mansel">Robert E. Mansel</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Bogaerts, Jan" sort="Bogaerts, Jan" uniqKey="Bogaerts J" first="Jan" last="Bogaerts">Jan Bogaerts</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Demonty, Gaston" sort="Demonty, Gaston" uniqKey="Demonty G" first="Gaston" last="Demonty">Gaston Demonty</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Duez, Nicole" sort="Duez, Nicole" uniqKey="Duez N" first="Nicole" last="Duez">Nicole Duez</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Cataliotti, Luigi" sort="Cataliotti, Luigi" uniqKey="Cataliotti L" first="Luigi" last="Cataliotti">Luigi Cataliotti</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Klinkenbijl, Jean" sort="Klinkenbijl, Jean" uniqKey="Klinkenbijl J" first="Jean" last="Klinkenbijl">Jean Klinkenbijl</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Westenberg, Helen A" sort="Westenberg, Helen A" uniqKey="Westenberg H" first="Helen A." last="Westenberg">Helen A. Westenberg</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Van Der Mijle, Huub" sort="Van Der Mijle, Huub" uniqKey="Van Der Mijle H" first="Huub" last="Van Der Mijle">Huub Van Der Mijle</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Hurkmans, Coen" sort="Hurkmans, Coen" uniqKey="Hurkmans C" first="Coen" last="Hurkmans">Coen Hurkmans</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author><author><name sortKey="Rutgers, Emiel J T" sort="Rutgers, Emiel J T" uniqKey="Rutgers E" first="Emiel J. T." last="Rutgers">Emiel J. T. Rutgers</name><affiliation wicri:level="1"><nlm:aff id="aff1">From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze, Italy.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Italie</country><wicri:regionArea>From the Departments of Surgical Oncology and Radiation Oncology, the Netherlands Cancer Institute; Department of Radiation Oncology, Academic Medical Centre, Amsterdam; Department of Surgery, University Medical Centre, Leiden; Department of Surgery, Rijnstate Hospital; Department of Radiation Oncology, Arnhem Radiotherapy Institution Institute for Radiation Oncology, Arnhem; Department of Surgery, Nij Smellinghe Hospital, Drachten; Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands; Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom; European Organisation of Research and Treatment of Cancer, Brussels, Belgium; and the Department of Surgery, Universita Degli studi di Firenze, Firenze</wicri:regionArea><wicri:noRegion>Firenze</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of Clinical Oncology</title><idno type="ISSN">0732-183X</idno><idno type="eISSN">1527-7755</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>The After Mapping of the Axilla: Radiotherapy or Surgery? (AMAROS) phase III study compares axillary lymph node dissection (ALND) and axillary radiation therapy (ART) in early breast cancer patients with tumor-positive sentinel nodes. In the ART arm, the extent of nodal involvement remains unknown, which could have implications on the administration of adjuvant therapy. In this preliminary analysis, we studied the influence of random assignment to ALND or ART on the choice for adjuvant treatment.</p></sec><sec><title>Patients and Methods</title><p>In the first 2,000 patients enrolled in the AMAROS trial, we analyzed the administration of adjuvant systemic therapy. Multivariate analysis was used to assess variables affecting the administration of adjuvant chemotherapy. Adjuvant therapy was applied according to institutional guidelines.</p></sec><sec><title>Results</title><p>Of 2,000 patients, 566 patients had a positive sentinel node and were treated per random assignment. There was no significant difference in the administration of adjuvant systemic therapy. In the ALND and ART arms, 58% (175 of 300) and 61% (162 of 266) of the patients, respectively, received chemotherapy. Endocrine therapy was administered in 78% (235 of 300) of the patients in the ALND arm and in 76% (203 of 266) of the patients in the ART arm. Treatment arm was not a significant factor in the decision, and no interactions between treatment arm and other factors were observed. Multivariate analysis showed that age, tumor grade, multifocality, and size of the sentinel node metastasis significantly affected the administration of chemotherapy. Within the ALND arm, the extent of nodal involvement remained not significant in a sensitivity multivariate analysis.</p></sec><sec><title>Conclusion</title><p>Absence of knowledge regarding the extent of nodal involvement in the ART arm appears to have no major impact on the administration of adjuvant therapy.</p></sec></div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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