Does the Stellate Ganglion Block Reduce Severe Hot Flushes and Sleep Disturbances in Breast Cancer Patients

Background: Invalidating hot flushes and night sweats leading to sleep dysfunction and poor quality of life are difficult to treat, especially in postmenopausal breast cancer patients likely to take an anti-estrogen. Lipov et al. (Lancet Oncology 2008; 9: 523-32) recently reported on the therapeutic value of the ganglion stellatum block (GSB) in 13 patients. We here report results from a pilot and prospectively planned study using the GSB in symptomatic breast cancer patients. Methods and Patients: Both studies were approved by our ethical committee and included postmenopausal women with severe hot flushes and/or night sweats and no contra-indication for GSB. Patients had to sign a consent form after information and were recruited from the follow-up breast cancer clinic. Hot flushes were recorded in a daily diary by use of the hot-flash score (Lipov et al.) and night awakenings by use of the Pittsburgh Sleep Quality Index. Improvement was estimated by the patient from 0-100 %. The pilot cohort compared both instruments between baseline and after 1 month whereas the prospective study compared baseline, weeks 1, 12 & 24 following the GSB. Patients were treated as out-patients in the pain clinic with a right side GSB at the anterolateral aspect of C6 vertebra under fluoroscopy by an experienced anesthetist injecting 10 cc Chirocaine. A contralateral block was placed when no satisfactory result. Results: The pilot study included 9 patients and as of today, 18 of 25 patients are included in the prospective study. The temporary Horner syndrome confirmed the GSB in all. In the pilot study, 5/9 patients had the GSB unilateral and 4/9 bilateral. Three of 9 patients had no improvement in either endpoint while 6/9 reported an improvement in severity of hot flushes and in quality of sleep. Two patients had a complete disappearance of the hot flushes and perfect sleep quality following a unilateral GSB. Three patients with contralateral GSB experienced an 80%, 70% and 50% improvement. Another patient with GSB unilateral experienced improvement by 20% in both instruments. We report results of 6 patients in the prospective study, 3 required a contralateral GSB. Their mean baseline hot flash score was 2.5 down to 2.2 after one week of GSB. Mean sleep hours improved from 6 to 7.25 hours per night even at week 1 after the GSB. One reported a hot flash score of 2.5/1.6/1.5/1.9 respectively mentioned follow up period. Because of rising hot flash score she asked for a third GSB after 24 weeks. Conclusion: This pilot and prospectively planned study to test efficacy of GSB on hot flushes and/or night sweats confirmed that breast cancer patients suffering from invalidating symptoms may benefit with no short term harm. Further results of the patients in both studies will be presented during the meeting. This will also answer the question whether long term efficacy remains. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 809.