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If chemotherapy has cleared the lymph nodes completely, does the armpit still need an operation or radiotherapy? This British trial is asking, with arm swelling counted as an equal endpoint to survival. It is still recruiting.
ATNEC opened on 26 February 2021 and is recruiting towards an estimated 1,900 participants, with an estimated primary completion of February 2030. Patients whose nodal disease was proven by needle biopsy at diagnosis and whose sentinel node biopsy after chemotherapy shows no residual cancer are randomised to no further axillary treatment or to axillary treatment, which is either clearance or radiotherapy.
The design says something about how the field has changed. Disease-free survival and patient-reported lymphoedema are co-primary outcomes, not primary and secondary: the trial is built to fail if the de-escalation is safe but the two arms cannot be separated on arm morbidity, and to succeed on the same footing if it spares arms. Funding is from the National Institute for Health and Care Research under reference NIHR 128311.
ATNEC sits alongside NSABP B-51, which asked the radiotherapy half of the same question and found that regional nodal irradiation adds nothing when the nodes clear. No ATNEC results have been published and none are quoted here.
Shares POSNOC, Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Sentinel lymph node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Sentinel lymph node biopsy.
Shares POSNOC, Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Sentinel lymph node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Sentinel lymph node biopsy.
Shares POSNOC, Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Sentinel lymph node biopsy.