Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Cancer
(Impact Factor: 4.89).
07/2012; 118(13):3337-44. DOI: 10.1002/cncr.26550
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.
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.
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).
Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.
Available from: Sheila N Garland
- "Our study also found that almost half of the patients had no knowledge of acupuncture, and that any knowledge of acupuncture was associated with twice the likelihood of willingness to use acupuncture. As more evidence emerges regarding the use of acupuncture in the oncology setting  , it is critically important to disseminate such knowledge to patients and providers because there is a correlation between the degree to which patients are informed and their use of CAM . With this information, patients and providers can make informed decisions about incorporating acupuncture into care with the goals of managing symptoms and improving quality of life. "
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Acupuncture has potential as a supportive care service for cancer symptom management. However, little is known about patients’ willingness to use acupuncture in the context of conventional cancer care.
We conducted a cross-sectional survey study among patients with cancer during their last week of fractionated/external beam radiotherapy (RT). The main outcome variable was self-reported likelihood of using acupuncture during RT. Knowledge about acupuncture and pain severity was measured along with socio-demographic and clinical variables. Multivariate logistic regression was performed to identify factors associated with willingness to use acupuncture.
Among the 305 participants, 79 (26.4%) were likely to use acupuncture during RT if such services were offered at a reasonable price, 143 (46.9%) had no knowledge of acupuncture, and 206 (67.6%) reported having pain. In multivariate analyses, non-Whites (adjusted odds ratio [AOR] 1.94, 95% Confidence Interval [CI] 1.06-3.56), and those with pain (AOR 2.52, CI 1.25-5.10) were more interested in using acupuncture. In addition, patients with preexisting knowledge about acupuncture were also more likely to use acupuncture than those without this knowledge (AOR 2.23, CI 1.28-3.88).
Patients of non-White race, those with pain or those with prior knowledge about acupuncture were more willing to utilize acupuncture during RT. Since half of the patients had no knowledge about acupuncture, interventions to improve patients’ knowledge are needed to facilitate the successful integration of acupuncture into cancer care.
Available from: Tsair-Fwu Lee
- "External radiation therapy (RT) of nasopharyngeal carcinoma (NPC) typically involves bilateral parotid gland and leads to xerostomia of varying degree             . High radiation dose to the salivary glands causes a marked reduction in oral saliva output, the degree of which depends on how much of the salivary gland volume irradiated and the radiation dose to these organs. "
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A "dose bricks" concept has been used to implement nasopharyngeal carcinoma treatment plan; this method specializes particularly in the case with bell shape nasopharyngeal carcinoma case.
Materials and methods:
Five noncoplanar fields were used to accomplish the dose bricks technique treatment plan. These five fields include (a) right superior anterior oblique (RSAO), (b) left superior anterior oblique (LSAO), (c) right anterior oblique (RAO), (d) left anterior oblique (LAO), and (e) superior inferior vertex (SIV). Nondivergence collimator central axis planes were used to create different abutting field edge while normal organs were blocked by multileaf collimators in this technique.
The resulting 92% isodose curves encompassed the CTV, while maximum dose was about 115%. Approximately 50% volume of parotid glands obtained 10-15% of total dose and 50% volume of brain obtained less than 20% of total dose. Spinal cord receives only 5% from the scatter dose.
Compared with IMRT, the expenditure of planning time and costing, "dose bricks" may after all be accepted as an optional implementation in nasopharyngeal carcinoma conformal treatment plan; furthermore, this method also fits the need of other nonhead and neck lesions if organ sparing and noncoplanar technique can be executed.
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ABSTRACT: Radiotherapy-induced xerostomia seriously reduces the quality of life (QOL) for patients with head and neck cancer. This study aimed to investigate the effects of manual acupuncture on objective and subjective assessment of symptom changes in patients with cancer who have with radiation-induced xerostomia.
Twelve (12) patients with radiation-induced xerostomia were randomized into 2 groups (real or sham acupuncture). Acupuncture was conducted twice weekly for 6 weeks in a single-blind setting. The effect was evaluated by measuring whole salivary flow rates (stimulated and unstimulated) and questionnaire-based assessment of subjective symptoms pre- and post-treatment (3 and 6 weeks after acupuncture treatment).
Both groups showed a slight increase in whole salivary flow rates, with no significant difference between them. However, real acupuncture markedly increased unstimulated salivary flow rates, and improved the score for dry mouth according to the xerostomia questionnaire, by 2.33 points versus 0.33 in the controls.
Our results showed the significantly meaningful amelioration of the subjective sensation of xerostomia closely associated with QOL in patients with head and neck cancer treated with irradiation.
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