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The AMAROS randomized trial compared axillary lymph node dissection with axillary radiotherapy in patients with a positive sentinel lymph node in early breast cancer. The study asked whether radiotherapy could provide adequate regional control while reducing the morbidity associated with surgical clearance of the axilla. Long-term follow-up demonstrated very low axillary recurrence rates with both approaches. Axillary radiotherapy was associated with less treatment-related morbidity, particularly a lower burden of lymphedema compared with axillary dissection. For surgeons, the study reinforces the move toward individualized axillary management. A positive sentinel node does not automatically mean that complete dissection is the only oncologically sound option. In selected patients, radiotherapy can provide regional control while avoiding additional surgery. The practical value of AMAROS is therefore less about declaring one treatment universally superior and more about expanding the set of safe options available through multidisciplinary planning. The final decision depends on tumour features, extent of nodal disease, prior surgery, radiotherapy plans and patient priorities. For breast teams, AMAROS is a landmark example of how de-escalation can reduce morbidity without abandoning oncological control.
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The AMAROS randomized trial compared axillary lymph node dissection with axillary radiotherapy in patients with a positive sentinel lymph node in early breast cancer. The study asked whether radiotherapy could provide adequate regional control while reducing the morbidity associated with surgical clearance of the axilla. Long-term follow-up demonstrated very low axillary recurrence rates with both approaches. Axillary radiotherapy was associated with less treatment-related morbidity, particularly a lower burden of lymphedema compared with axillary dissection. For surgeons, the study reinforces the move toward individualized axillary management. A positive sentinel node does not automatically mean that complete dissection is the only oncologically sound option. In selected patients, radiotherapy can provide regional control while avoiding additional surgery. The practical value of AMAROS is therefore less about declaring one treatment universally superior and more about expanding the set of safe options available through multidisciplinary planning. The final decision depends on tumour features, extent of nodal disease, prior surgery, radiotherapy plans and patient priorities. For breast teams, AMAROS is a landmark example of how de-escalation can reduce morbidity without abandoning oncological control.
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