Acupuncture reduces the frequency and severity of xerostomia (dry mouth). University of Texas MD Anderson Cancer Center (Houston) and Fudan University Cancer Center (Shanghai) researchers conducted a randomized controlled clinical trial. The phase-three patient and assessor blinded investigation of acupuncture’s effects on head and neck cancer patients receiving radiation therapy demonstrated groundbreaking results. The researchers concluded that acupuncture “resulted in significantly fewer and less severe RIX [radiation-induced xerostomia] symptoms 1 year after treatment vs SCC [standard care control].” [1]

Salivary glands may be temporarily or permanently damaged by radiation therapy. There is a high-incidence of RIX, which may lead to complications including difficult or painful swallowing, impairment of the sense of taste (dysgeusia), and dental problems. Other RIX complications may include insomnia and difficulty speaking.

The study compared true acupuncture, sham acupuncture, and standard care control groups. True acupuncture produced significantly greater positive patient outcomes than the other groups. Outcome measures were based on a questionnaire, salivary flow, incidence of xerostomia, salivary contents, and quality of life scores. One year after completion of all acupuncture treatments, the true acupuncture group maintained significantly higher patient outcome rates over the standard care and sham groups.

All acupuncture treatments were provided by credentialed acupuncturists. The researchers note that their findings are consistent with several prior investigations. True acupuncture patients that received acupuncture three times per week during their six to seven week course of radiation therapy had significantly less dry mouth a year after completion of treatments than standard care control patients. No adverse effects occurred at University of Texas MD Anderson. One adverse effect was reported at the Fudan study location.

The researchers find that acupuncture is superior to standard care for the relief of radiation induced xerostomia. They comment that acupuncture is “minimally invasive” and “has a very low incidence of adverse effects.” [2] Based on the evidence, further research is warranted.

All participants in the study were at least 18 years of age, provided informed consent, had a diagnosis of head and neck carcinoma, and were scheduled for radiation therapy at a mean dose of 24 Gy to a minimum of one parotid gland. An extensive list of exclusion criteria was used to prevent variables created by comorbidity.

All acupuncturists providing treatment during the course of the study were licensed and were prepared and trained at the University of Texas MD Anderson Cancer Center. The acupuncture point prescription chosen for the study was the following:

  • CV24
  • LU7
  • KD6
  • Auricular: Shenmen, Point Zero, Salivary Gland 2 Prime, Larynx

Standard needle depths were used and the elicitation of deqi at the acupoints was at the discretion of treating acupuncturists. Notably, once deqi was elicited, needles were no longer manually stimulated (with the exception of displaced needles). Electroacupuncture was not used at any point.

Body-style acupuncture needles were of 0.25 mm diameter and 40 mm length. Auricular acupuncture needles were of 0.16 diameter and 15 mm length. Acupuncture treatments were provided a total of three times per week for the duration of the 6-7 week radiation treatment period.

The researchers chose to avoid the use of local points other than CV24 with the intent of preventing disturbance of tissues damaged by radiation. All patients were treated on the day of radiation therapy in a semisupine or supine position. Acupuncture was applied either before or after radiation therapy. Based on the data, the researchers note that acupuncture “should be considered for the prevention of radiation-induced xerostomia.” [3]

The investigators note that prior research indicates that acupuncture regulates blood flow at the parotid glands. In addition, a variety of other studies find acupuncture effective for the treatment of xerostomia. One of the studies cited in the investigation finds acupuncture effective for up to three years after treatment. Two pilot studies by the research group prior to this phase three clinical trial find acupuncture effective for the prevention of RIX if provided with radiation therapy.

The study employed strict controls and researchers monitored treatment facilities and licensed acupuncturists during the investigation. Further research will help to support standardization of acupuncture protocols for the prevention and treatment of RIX for inpatient and outpatient settings.

 

References:
1. Garcia, M.K., Meng, Z., Rosenthal, D.I., Shen, Y., Chambers, M., Yang, P., Wei, Q., Hu, C., Wu, C., Bei, W. and Prinsloo, S., 2019. Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer: A Randomized Clinical Trial. JAMA Network Open, 2(12), pp.e1916910-e1916910.
2. Ibid.
3. Ibid.

 

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