Acupuncture Shows Potential for Xerostomia

Lorenzo Cohen, PhD

Acupuncture may help prevent xerostomia in patients with nasopharyngeal carcinoma undergoing radiotherapy and may also reduce symptom severity, new results suggest.

Lorenzo Cohen, PhD, professor in the Department of General Oncology and in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center in Houston, and coworkers randomized 86 patients to receive either acupuncture or conventional treatment involving oral hygiene measures during their 7-week course of radiotherapy. Patients were treated 3 times a week on the same days they received radiotherapy.

Participants were 18 years of age or older with nasopharyngeal carcinoma, anatomically intact parotid, submandibular glands, and Zubrod performance status of 0, 1, or 2.

Most patients with cancers of the head and neck undergo radiotherapy and develop xerostomia as a result, the authors pointed out. The condition is characterized by a decrease in salivary flow that starts during the first few days of radiation therapy and leads to an 80% reduction in salivary flow by 6 weeks. Quality of life may be markedly decreased as patients may experience taste abnormalities, dysphagia, odynophagia, difficulty sleeping and speaking, and loss of appetite. Importantly, decreased salivary flow may also increase microbial growth and potentiate bone infection and irreversible nutritional deficiency.

Treatments are largely palliative and have included saliva substitutes, chewing gum, sialogogue lozenges, electrical stimulation of the tongue and palate, hyperbaric oxygen therapy, and pilocarpine; all have produced minimal benefit. Amifostine is indicated to decrease the incidence and severity of radiationinduced xerostomia, but it requires parenteral administration, is associated with unpleasant side effects (drowsiness, feeling of coldness, flushing/feeling of warmth, hiccups, nausea, sneezing, and vomiting), and may not be readily available.

Acupuncture has been shown to promote salivary flow in patients who develop xerostomia after they have completed radiation therapy. However, the present study is the first to use a randomized design to examine whether the treatment can prevent xerostomia when used concurrently with radiotherapy.

Subjective measures in the study included the Xerostomia Questionnaire (XQ) and the MD Anderson Symptom Inventory for Head/Neck Cancer. (MDASI-HN).

Differences in the incidence of xerostomia, cancer-related symptoms that compromise the quality of life, and salivary flow rates between the active treatment and control groups were apparent as early as 3 weeks after the start of radiotherapy.

The present study is the first to use a randomized design to examine whether the treatment can prevent xerostomia when used concurrently with radiotherapy.

The most pronounced differences were observed by the end of radiotherapy; however, the differences persisted over time. At 1 month after the end of radiation therapy, 54.3% of the acupuncture group reported XQ scores >30 versus 86.1% of controls (relative risk [RR] = 0.63; 95% CI, 0.45-0.87; P = .0019). XQ scores ≤ 30 indicate mild to no symptoms of xerostomia. At 6 months, 24.1% and 63.6% of patients in the 2 groups, respectively (RR = 0.38; 95% CI, 0.19-0.76; P = .0018] had scores >30.

The acupuncture group had higher salivary flow rates on standardized sialometry collection techniques, and also fewer nonxerostomia cancer-related symptoms. The difference between the 2 groups on both measures started to emerge at the third week and continued throughout the 6-month follow-up period.

Except for mild discomfort related to needle insertion, there were no reports of adverse effects related to treatment.

The researchers emphasize that the findings are not necessarily generalizable because the study was conducted at a single institution. Future studies with longer follow-up are needed to elucidate the role of acupuncture in xerostomia and to clarify its mechanism of action.

Meng Z, Garcia MK, Hu C, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma [published online ahead of print November 9, 2011]. Cancer. doi: 10.1002/cncr.26550