American Association of Plastic Surgeons

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Taxane-Based Neoadjuvant Chemotherapy Adversely Impacts Lymphatic Contractility Rates
Melisa Granoff, BA1, Anna Rose Johnson, MPH1, Jordan Broekhuis, MD1, Echoe Bouta, PhD2, Timothy Padera, PhD2, Bernard Lee, MD, MBA, MPH, FACS1, Dhruv Singhal, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Massachusetts General Hospital, Boston, MA, USA.

PURPOSE: Although taxane-based chemotherapy has been identified as an independent risk factor for the development of lymphedema in certain studies, the quantitative effect of this therapy on lymphatic contractility remains unexamined. Indocyanine green (ICG) fluorescent lymphography permits the evaluation of superficial lymphatic channels using real-time near-infrared imaging technology. In this study, we quantify and compare lymphatic contractility in unilateral breast cancer patients undergoing ICG lymphangiograms.
METHODS: Pre-operative ICG lymphangiograms were obtained on patients with unilateral breast cancers and nodal disease prior to oncologic resection. Two ICG injections of the dorsal hand were performed and recorded for 3 minutes. Regions of interest (ROIs) were selected on each lymphatic channel and signal intensity was recorded to generate contractility curves. Each peak in signal intensity corresponded with a lymphatic contraction, and was identified using a systematic, algorithmic approach.
RESULTS: Seventeen patients with unilateral breast cancers requiring axillary nodal dissection underwent pre-operative ICG lymphography. Eight of the 17 patients underwent taxane-based neoadjuvant chemotherapy. The mean contraction frequency in patients who received neoadjuvant taxane-based chemotherapy was 0.67 contractions/minute (c/m) compared to 1.32 c/m (p=0.1).
CONCLUSION: Utilizing a novel method for quantifying and evaluating lymphatic contractility patterns during ICG lymphangiography, we have noted a near 50% decrease in rate of in patients who received neoadjuvant taxane-based chemotherapy. Further follow-up of this patient cohort is needed to determine whether decreased contractility rate corresponds with lymphatic disease development. However, this observation may have important implications in guiding the timing of surgical intervention, surveillance frequency, and post-operative therapeutic interventions.


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