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.