Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma

Abstract

Background: Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients, and available treatments are of little benefit. The objective of this trial was to determine whether acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy.

Methods: A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3×/wk on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates. Patients were followed for 6 months after the end of radiotherapy.

Results: Xerostomia Questionnaire scores for acupuncture were statistically significantly lower than for controls starting in week 3 through the 6 months (P = .003 at week 3, all other P < .0001), with clinically significant differences as follows: week 11, relative risk (RR) 0.63 (95% confidence interval [CI], 0.45-0.87); 6 months, RR 0.38 (95% CI, 0.19-0.76). Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (unstimulated whole salivary flow rate, P = .0004), with greater saliva flow in the acupuncture group at week 7 (unstimulated whole salivary flow rate, P < .0001; stimulated whole salivary flow rate, P = .002) and 11 (unstimulated whole salivary flow rate, P < .02; stimulated whole salivary flow rate, P < .03) and at 6 months (stimulated whole salivary flow rate, P < .003).

Conclusions: Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.

Figure 1

Patient flow diagram* * Five patients died before the 6-month follow-up and the other 19 dropped out because they could not return to the hospital for the assessments.

Figure 2

Xerostomia Questionnaire mean scores over time. * * Week 0 is baseline raw mean. Means at weeks 1 through 11 are the least square means adjusted for baseline score. The perpendicular lines at each time point represent the standard error.

Figure 3

MD Anderson Symptom Inventory Head and Neck Questionnaire mean scores over time.* * Week 0 is baseline raw mean. Means at weeks 1 through 11 are the least square means adjusted for baseline score. The perpendicular lines at each time point represent the standard error.

Figure 3

MD Anderson Symptom Inventory Head and Neck Questionnaire mean scores over time.* * Week 0 is baseline raw mean. Means at weeks 1 through 11 are the least square means adjusted for baseline score. The perpendicular lines at each time point represent the standard error.

Figure 4

Acupuncture versus Control (standard of care) saliva flow outcomes over time.* * Week 0 is baseline raw mean. Means at weeks 1 through 11 are the least square means adjusted for baseline score. The perpendicular lines at each time point represent the standard error.