Pilot evaluation of a stellate ganglion block for the treatment of hot flashes

Abstract

Purpose Hot flashes are a significant problem in breast cancer patients, especially because the most effective therapy, estrogen, is often contraindicated. Based on recent pilot data from a single group supporting the use of a stellate ganglion block for the treatment of hot flashes, the present pilot trial was done to further evaluate the hypothesis that a stellate ganglion block may be a safe and effective therapy for hot flashes. Methods In women with breast cancer who had hot flashes, a stellate ganglion block was performed after 1 week of baseline hot flash data collection. The main efficacy measures were the changes from baseline in hot flash frequency and hot flash score during the 6th week. Results Ten patients were enrolled between 4/23/2009 and 7/10/2009; eight patients were evaluable. After the stellate ganglion block, the mean hot flash frequency and score decreased from baseline values by over 60% during some of the post-treatment weeks. The mean hot flash frequency and score at week 6 decreased from baseline values by 44% and 45%, respectively. There were no significant adverse events clearly attributed to the stellate ganglion blocks. Conclusions The results of this pilot trial support that stellate ganglion blocks may be a helpful therapy for hot flashes. A prospective placebo-controlled clinical trial should be done to more definitively determine this contention.

Effects of stellate ganglion block on vasomotor symptoms

“…13 SGB decreased mean hot flash frequency by 44% at six weeks in 10 breast cancer survivors who failed conventional VMS treatment. 14 SGB led to a 47% decrease in hot flash scores at 24 weeks in 34 women with non-recurrent early stage postmenopausal breast cancer and severe VMS with a positive effect on sleep observed over the 24-week follow up. 15 In another uncontrolled trial of SGB in 19 post-menopausal women, a 34% decrease in hot flash scores was seen at 4 weeks following SGB in “responders”, though 10 of the 19 women were “non-responders” with 0–11% reduction in hot flash scores.…”

“…All patients in the SGB group exhibited a Horner’s sign immediately after the injection, confirming a successful sympathetic block, whereas failure to identify a Horner’s sign occurred in 5–22% in prior studies. 14,15 Nonetheless, our study has several limitations. The sample size was only 40 women, though this is the largest clinical study of SGB for the treatment of VMS to date.…”

Risk factors, pathophysiology, and treatment of hot flashes in cancer

“…208 In another study, 10 breast cancer patients received stellate ganglion block, with 8 evaluable patients showing a decrease in hot flash frequency and hot flash scores of 44% and 45% respectively. 209 No significant adverse events were reported. 209 An additional uncontrolled trial showed similar benefits for reducing hot flash scores (64% after 1 week, 47% after 24 weeks) and improving sleep at 1 and 24 weeks.…”

Androgen deprivation therapy-associated vasomotor symptoms

“…Potential treatments include hypnosis, 62 paced breathing/yoga and stellate ganglion block. 63–66 Most of these have shown promise in pilot studies in women, but have not been studied in men with ADT-associated hot flashes. More information and evidence examining use of these methods of therapy will hopefully become available over the next several years.…”