Johnson Anna Rose, Granoff Melisa D, Lee Bernard T, Padera Timothy P, Bouta Echoe M, Singhal Dhruv
Department of Radiation Oncology, Edwin L. Steele Laboratory, Massachusetts General Hospital, Boston, MA.
Ann Plast Surg. 2019 Apr;82(4S Suppl 3):S173-S178. doi: 10.1097/SAP.0000000000001884.
Breast cancer-related lymphedema affects 700,000 breast cancer survivors in the United States. Although taxane-based chemotherapy regimens are commonly used in the treatment of breast cancer, the impact of taxanes on the lymphatic system remains poorly understood. This study aims to examine the influence of taxane-based chemotherapy on lymphatic function in breast cancer patients.
A retrospective review of a prospectively-maintained database was performed. Consecutive patients with node positive breast cancer who underwent preoperative indocyanine green (ICG) lymphangiograms were identified. Information including patient demographics, baseline measurements, cancer characteristics, and treatment information were retrieved. Preoperative ICG lymphangiography videos were analyzed and lymphatic contractility was quantified for each subject. Multiple regions of interest were selected on each lymphatic channel and signal intensity was recorded for 3 minutes to generate contractility curves. Each lymphatic contraction was identified using a novel, systematic, and algorithmic approach.
Twenty-nine consecutive patients with unilateral node-positive breast cancer were included for analysis. Average patient age was 54.5 (13) years and mean BMI was 26.8 kg/m (4). The mean lymphatic contractility of patients who received taxane-based neoadjuvant chemotherapy was 0.7 contractions/minute (c/m) (n = 19) compared to 1.1 c/m in those who received no neoadjuvant therapy (n = 10), (P = 0.11). In subgroup analysis, patients who reported taxane induced neuropathy demonstrated significantly lower lymphatic contractility values than those who were asymptomatic or did not receive any chemotherapy (P = 0.018).
In this study, we used a novel method for quantifying and evaluating lymphatic contractility rates in routine ICG lymphangiograms. Diminished lymphatic contractility was noted in patients who received taxane-based neoadjuvant chemotherapy compared with those who did not. Taxane-based neoadjuvant chemotherapy may adversely affect the lymphatic system in the breast cancer population. A larger patient cohort with longer follow-up time is needed to validate this finding and evaluate any potential association with breast cancer-related lymphedema development.
在美国，乳腺癌相关淋巴水肿影响着70万乳腺癌幸存者。尽管基于紫杉烷的化疗方案常用于乳腺癌治疗，但紫杉烷对淋巴系统的影响仍知之甚少。本研究旨在探讨基于紫杉烷的化疗对乳腺癌患者淋巴功能的影响。
对一个前瞻性维护的数据库进行回顾性分析。纳入连续接受术前吲哚菁绿（ICG）淋巴管造影的淋巴结阳性乳腺癌患者。检索患者人口统计学、基线测量、癌症特征和治疗信息。分析术前ICG淋巴管造影视频，对每个受试者的淋巴收缩性进行量化。在每个淋巴通道上选择多个感兴趣区域，记录3分钟的信号强度以生成收缩性曲线。使用一种新颖、系统的算法方法识别每次淋巴收缩。
纳入29例连续的单侧淋巴结阳性乳腺癌患者进行分析。患者平均年龄为54.5（13）岁，平均BMI为26.8 kg/m（4）。接受基于紫杉烷新辅助化疗的患者平均淋巴收缩性为0.7次/分钟（c/m）（n = 19），而未接受新辅助治疗的患者为1.1 c/m（n = 10），（P = 0.11）。在亚组分析中，报告紫杉烷引起神经病变的患者淋巴收缩性值明显低于无症状或未接受任何化疗的患者（P = 0.018）。
在本研究中，我们使用了一种新颖的方法来量化和评估常规ICG淋巴管造影中的淋巴收缩率。与未接受者相比，接受基于紫杉烷新辅助化疗的患者淋巴收缩性降低。基于紫杉烷的新辅助化疗可能对乳腺癌患者的淋巴系统产生不利影响。需要更大的患者队列和更长的随访时间来验证这一发现，并评估与乳腺癌相关淋巴水肿发生的任何潜在关联。
