Peter A.S. Johnstone, MD, MA*
Y. Peter Peng, MD*
Bryon C. May, MD*
Warren S. Inouye, MD*
Richard C. Niemtzow, MD, PhD, MPH*
*Radiation Oncology Division, Naval Medical Center, San Diego, CA 92134-1014
PURPOSE/OBJECTIVE
Patients with xerostomia refractory to pilocarpine therapy were offered
acupuncture (AP) as potential palliation of their symptoms.
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PATIENTS AND METHODS
Eleven patients with refractory xerostomia after bilateral head and neck radiotherapy
(XRT) have been treated with AP and are the subject of this report. Nine patients (4 NP, 5
OP primaries) had been treated definitively, and 2 patients (1 each OC, and OP primaries)
had been treated post-operatively. Chemotherapy had been given in four cases (2 NP, 2 OP
primaries). Median XRT dose to the primary field was 70 Gy. Median latency post-XRT was 35
months. Ten patients had discontinued pilocarpine therapy because of lack of effect; one
was taking pilocarpine with minimal therapeutic effect. Full informed consent was obtained
prior to AP in each case. Patients were treated with a standard AP protocol and received a
median of 4 weekly treatments. Sterile AP needles were inserted by the same experienced
acupuncturist in all cases. Two bilateral hand points were needled in conjunction with
three bilateral auricular points. Response was assessed retrospectively using the
Xerostomia Inventory (XI) 1. Using this scale, higher numbers represent worse
toxicity (max = 50), and a score of 14.5 is normal.
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RESULTS
No adverse effects were referable to AP. A subjective increased degree of
salivation was present in 10 of 11 cases after AP. Below are objective patient responses
using the XI.
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CONCLUSION
Acupuncture using a standard protocol may contribute to less xerostomia for some
patients with refractory symptoms after radiotherapy. Longer follow-up, optimization of
technique and prospective objective measurement of response continue in our clinic.
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| Pt |
Stage/
Primary |
XRT
dose
(Gy) |
Time
post-
XRT |
Pre-
AC XI
score |
# AC
session |
Time
post-
AC |
Post-AC
XI
score |
| 1 |
IV / NP |
70 |
14 m |
37 |
4 |
1 w |
29 |
| 2 |
II / OT |
50 |
44 m |
39 |
4 |
8 w |
23 |
| 3 |
IV / Tonsil |
70 |
5 m |
35 |
3 |
1 w |
32 |
| 4 |
III / Tonsil |
64 |
30 m |
41 |
4 |
1 w |
41 |
| 5 |
IV / NP |
71.12 |
12 m |
41 |
4 |
8 w |
24 |
| 6 |
IV / NP |
70 |
40 m |
40 |
3 |
2 w |
29 |
| 7 |
III / Tonsil |
70.5 |
35 m |
36 |
4 |
3 w |
31 |
| 8 |
IV / BOT |
70 |
60 m |
43 |
4 |
4 w |
21 |
| 9 |
IV / BOT |
74.4 |
50 m |
42 |
5 |
5 w |
24 |
| 10 |
III / Tonsil |
70.5 |
24 m |
35 |
3 |
1 w |
35 |
| 11 |
IV / NP |
70 |
35 m |
40 |
5 |
4 w |
38 |
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1 Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:46-50.
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