Carboplatin or Carboplati-numb? The Effect of Carboplatin on Sensation Recovery of Deep Inferior Epigastric Perforator Flaps
Ashley Zhang, BSE1, Grant G. Black, BA1, Hao Huang, MD1, Chase Alston, MHS2, Matthew A. Wright, MD1, Marcos Lu Wang, MD1, Angela Ellison, PA-C1 and David M Otterburn, MD3, 1Weill Cornell Medicine, New York, NY, 2Weill Cornell Medicine, Weill Cornell Medical College, New York, NY, 3Division of Plastic Surgery, Weill Cornell Medicine, New York, NY
Purpose
Carboplatin, a platinum-based chemotherapy agent used in the treatment of breast cancer, is often added to standard chemotherapy regimens for patients with operable triple-negative disease. Platinum-induced peripheral neurotoxicity has been well-documented in cancer literature, but there remains a paucity of data regarding the effect of platinum-based chemotherapy agents on sensation of the postmastectomy reconstructed breast specifically. In this study, we aimed to measure carboplatin’s effect on sensation recovery in patients with deep inferior epigastric perforator (DIEP) flap-based breast reconstruction.
Methods
In this retrospective analysis of our prospective cohort study, we identified patients who underwent mastectomy with DIEP flap reconstruction who also received neoadjuvant or adjuvant chemotherapy. These patients were stratified by the presence of carboplatin in their chemotherapy regimen.. Baseline characteristics, operative details, patient-reported peripheral neuropathy, postoperative complications, and breast sensation data of this cohort were compared to patients who received non-carboplatin-based chemotherapy. Breast sensation was evaluated with a pressure-specified sensory device in 9 different regions of the breasts, at defined time points in the pre- and postoperative periods.
Results
We identified 59 patients (106 breasts) who were treated with neoadjuvant or adjuvant chemotherapy; 16 patients (27 flaps) received carboplatin while 43 patients (79 flaps) did not. There was no difference in age, weight of the DIEP flap, or smoking history between the two cohorts, but the carboplatin group had lower BMI (25.45 kg/m2 vs. 27.46 kg/m2, p=0.041) and higher rate of diabetes mellitus (33.3% vs. 7.6%, p=0.003) compared to the control group. 100% of patients receiving carboplatin were also treated with taxane-based chemotherapy, compared to 84.8% of patients in the control group, but this difference was not significant (p=0.072). Both groups had similar rates of peripheral neuropathy, as reported in clinical notes. Preoperative and 1-2 year postoperative sensation between the two groups were similar, but the carboplatin group had generally worse sensation in all areas of the breast 2-3 years postoperatively and significantly so in the inferior quadrant (81.62 g/mm2 vs. 44.75 g/mm2, p=0.003).
Conclusion
Patients treated with carboplatin chemotherapy demonstrate moderately decreased breast sensation in the long run, compared to those who did not receive carboplatin as part of their chemotherapy regimen. These findings suggest that patients undergoing chemotherapy with carboplatin should be counseled on this underreported side effect.
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