Acupuncture May Prevent Radiation-Induced Xerostomia in Head and Neck Cancer

Findings from a phase 3 study suggest that acupuncture may be used to prevent radiation-induced xerostomia in patients with head and neck cancer (JAMA Netw Open. 2019;2[12]:e1916910).

“Radiation-induced xerostomia (RIX) is a common, often debilitating, adverse effect of radiation therapy among patients with head and neck cancer. Quality of life can be severely affected, and current treatments have limited benefit,” assert M. Kay Garcia, DrPH, Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, and colleagues.

Seeking to determine whether acupuncture can prevent RIX in patients with head and neck cancer undergoing radiation therapy, Dr Garcia et al conducted a phase 3 clinical trial comparing a standard care control (SCC) with true acupuncture (TA) and sham acupuncture (SA) in 399 patients with oropharyngeal or nasopharyngeal carcinoma undergoing radiotherapy in comprehensive cancer centers in the United States and China.

Between December 16, 2011, and July 7, 2015, a total of 399 patients were included and randomized in the study to undergo TA or SA using a validated acupuncture placebo device 3 times weekly during a 6- to 7-week course of radiotherapy.

The primary end point of the study was RIX (determined via the Xerostomia Questionnaire) for combined institutions 1 year after completion of radiotherapy. The secondary end points incidence of clinically significant xerostomia (score >30), salivary flow, quality of life, salivary constituents, and the role of baseline expectancy as it pertains to acupuncture on outcomes.

Ultimately, 339 patients were included in the final analysis (mean age, 51.3 years), with 112 randomized to receive TA, 115 randomized to undergo SA, and 112 randomized to the SCC arm. On August 15, 2016, Dr Garcia and co-investigators conducted the final follow-up, and carried out analyses between February 1, 2019, and February 28, 2019.

For the primary aim, the adjusted least square mean (SD) xerostomia score in the TA group (26.6 [17.7]) was significantly lower than in the SCC group (34.8 [18.7]) (P = .001; effect size = -0.44) and marginally lower but not statistically significant different from the SA group (31.3 [18.6]) (P = .06; effect size = -0.26). Incidence of clinically significant xerostomia 1 year after radiation therapy ended followed a similar pattern, with 38 patients in the TA group (34.6%), 54 patients in the SA group (47.8%), and 60 patients in the SCC group (55.1%) experiencing clinically significant xerostomia (P = .009).

“Post hoc comparisons revealed a significant difference between the TA and SCC groups at both institutions, but TA was significantly different from SA only at Fudan University Cancer Center, Shanghai, China, and SA was significantly different from SCC only at the University of Texas MD Anderson Cancer Center,” Dr Garcia and colleagues reported.

“This randomized clinical trial found that TA resulted in significantly fewer and less severe RIX symptoms 1 year after treatment vs SCC,” they concluded.—Hina Porcelli