Acupuncture for dry mouth after head and neck radiotherapy
Radiotherapy to the head and neck can permanently dry the mouth. A randomised trial in the United States and China found that acupuncture given during radiotherapy reduced dry mouth a year later compared with standard care, an effect that needs confirming.
Overview
Xerostomia after head and neck radiotherapy is common and often permanent because salivary glands sit in the treatment field. In a three-arm randomised trial of 399 patients at Fudan University and MD Anderson (Garcia et al., JAMA Network Open 2019), acupuncture three times a week during radiotherapy reduced patient-reported xerostomia at 12 months compared with standard care, with sham acupuncture intermediate; the effect was clearer at the Chinese centre than the American one. Earlier small trials of acupuncture and of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS, RTOG 0537) for established xerostomia showed improvement in symptoms without objective salivary flow changes. Intensity-modulated radiotherapy that spares the parotids, and amifostine where used, remain the primary preventive measures.
How it works
Stimulation of points around the ear and hands is proposed to increase parasympathetic salivary drive and protect gland function during irradiation.
- Randomised, two-country trial with a sham arm
- Symptom benefit persisted to one year
- No meaningful adverse events
- Effect differed between centres
- Objective saliva measures rarely improve
- Needs replication before guideline adoption
Latest papers
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