Lumbar Sympathicolysis Attenuates Refractory Chemotherapy-Induced Peripheral Neuropathy in the Lower Extremities: A Prospective, Real-World Study.

Purpose Currently, there are limited effective treatment strategies available for refractory chemotherapy-induced peripheral neuropathy (CIPN). Lumbar sympathicolysis is a minimally invasive therapy and may offer an option for CIPN. This single-center, prospective, observational study aimed to evaluate the efficacy and safety of CT-guided lumbar sympathicolysis in alleviating multiple symptoms of refractory CIPN in the lower extremities.

Methods This single-arm study conducted at Henan Cancer Hospital from September 2022 to July 2024,twenty-five patients with refractory CIPN in both lower extremities received CT-guided lumbar sympathicolysis. The effectiveness of the treatment for pain, numbness, cold sensation, and dyskinesia was evaluated using a Numerical Rating Scale (NRS) at day 3, one month, and three months following treatment. Treatment response was defined as an NRS score reduction of ≥30%. Changes in NRS scores over time were analyzed using generalized estimating equations. Any adverse effects related to the treatment were recorded.

Results Postoperative NRS scores for pain, numbness, cold sensation, and dyskinesia at 3 days, 1 month, and 3 months were significantly lower than these assessed before the treatment. The pain improvement assessed with NRS scores was reported to be 61.1% at 3 days, 55.5% at 1 month, and 55.5% at 3 months by patients (n=18). The numbness improvement was 24.0% at day 3, 16.0% at 1 month, and 16.0% at 3 months (n=25). Cold sensation improvement (n=21) was 71.4%, 57.1%, and 52.4% at day 3, 1 month, and 3 months (n=21), respectively. The decreased dyskinesia sensation was reported by 50.0% at day 3 and 1 month, and 57.1% at 3 months (n=14). Overall, all symptoms were decreased by 68% at day 3, 64% at 1 month, and 60% at 3 months.

Conclusion The CT-guided lumbar sympathicolysis may offer substantial symptom relief for CIPN in the lower extremities without clinically significant adverse effects. These preliminary findings warrant further validation in larger, controlled studies.