In a patient with early-stage HR+ breast cancer receiving neoadjuvant chemotherapy, does the presence of a transtibial osseointegrated amputation implant increase the risk of infection during chemotherapy-induced neutropenia?
She has a complicated surgical history, including a prior triple arthrodesis with multiple revisions that ultimately resulted in a below-the-knee (transtibial) amputation. She now has an osseointegrated (OI) implant/prosthesis.
Given the potential for chemotherapy-induced neutropenia, is there an increased risk of infection related to the osseointegrated implant or the skin–implant interface during neoadjuvant chemotherapy? Are there any additional precautionary or preventive measures that should be considered to mitigate infectious complications and safely support her through neoadjuvant therapy and ultimately to curative-intent surgery?
2 Answers
Mednet MemberInvited Expert
Medical Oncology · Ohio State University
Answered on
Having a foreign object attached to a body does increase infection risk. However, this risk has to be weighed against the magnitude of benefit from chemotherapy in terms of reducing the risk of breast cancer recurrence and improving the chances of overall survival. I feel that in breast cancer patie...
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Mednet MemberInvited Expert
Medical Oncology · Warren Alpert Medical School of Brown University
Answered on
While I do not believe that this prior surgery increases her risk of neutropenia, it may well increase her risk of serious infection if/when she becomes neutropenic, due to the presence of this foreign body. As a result, I would select her chemotherapy regimen based on the risk of severe nadir neutr...
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