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POSTER
PRESENTATION
Acupuncture Technique For
Pilocarpine-Resistant Xerostomia Following Radiotherapy For Head And
Neck Malignancies
Richard C. Niemtzow, MD, PhD, MPH*
Bryon C. May, MD*
Y. Peter Peng, MD*
Warren S. Inouye, MD*
Peter A. Johnstone, MD, MA*
ABSTRACT
Background Radiation therapy for cancer can induce secondary
xerostomia. Acupuncture may be able to help salivary glands produce
saliva.
Objective To determine if acupuncture would stimulate saliva
secretion in patients who were treated with radiation therapy.
Design and Setting Prospective case series in physician acupuncture
practice.
Patients Twelve patients with xerostomia secondary to radiation
therapy for head and neck cancer. In several cases, xerostomia was refractory
to conventional pilocarpine therapy.
Intervention A 2-phase acupuncture approach.
Main Outcome Measure Stimulation of saliva.
Results Follow-up evaluations over several weeks found that the
oral buccal mucosa was moist and saliva was present in all patients;
no adverse effects were reported.
Conclusion Acupuncture was offered as a potential palliation
of their symptoms, and it stimulated saliva secretion to various degrees.
KEY WORDS
Head, Neck, Cancer, Malignancy, Tumors, Xerostomia, Radiotherapy, Acupuncture,
Saliva, Electro-Auriculotherapy
PATIENTS
AND METHODS
Twelve patients having head and neck cancers were treated with radiation
therapy and consequently developed xerostomia. The condition was refractory
to pilocarpine; acupuncture was offered as a possible therapy.
There is no standard acupuncture protocol for xerostomia secondary to
radiation therapy, only suggested points.1,2 The acupuncture treatment
used is performed in 2 phases: phase 2 is introduced if response to phase 1 is inadequate. Phase 1 includes a sterile needle
(Seiren Laser L type needles gauge 3, length 30 mm, distributed by OMS
Medical Supplies Inc., Braintree, Mass), inserted bilaterally into LI
2 or 3.3 In addition, auriculotherapy points Point Zero, Shen Men, and Salivary Gland (C) II are needled bilaterally.
After 20 minutes if no saliva secretion is apparent, phase 2 is initiated
and the needles at salivary glands (C) II are removed. Electro-stimulation
of salivary gland (C) II points at 40 mA at 10 Hz with an electro-auriculotherapy
stimulator (40A or 400A Stem-Flex, manufactured by Electro Therapy Association,
Tulsa, Oklahoma), for 30 seconds bilaterally is performed. Also, salivary
gland (F) I at 40 mA at 10 Hz for 30 seconds bilaterally is stimulated.
Salivary glands (C) II are re-needled. Stimulate LI 4 bilaterally for
10 seconds using a piezoelectric stimulator (manufactured by ITO Co.
Ltd., Tokyo, Japan; distributed by OMS Medical Supplies Inc).
RESULTS
There were no adverse effects due to acupuncture. An increased degree
of salivation was subjectively present in all patients after acupuncture.
Follow-up evaluations up to 1 month found that the oral buccal mucosa
was moist and saliva was present. All patients were capable of expectoration.
We recommend that patients be treated twice weekly, then once every
3 to 4 weeks depending on the severity of their xerostomia.
DISCUSSION
Curative doses of radiation to the head and neck area for malignancies
can cause secondary xerostomia. Acupuncture can stimulate the salivary
glands to produce saliva when pilocarpine therapy is ineffective. In
some patients resistant to pilocarpine therapy, it appears that acupuncture
must activate the salivary glands through another mechanism. More acupuncture
research is necessary to define this corrective mechanism for xerostomia
produced by radiation therapy in cancer patients.
CONCLUSION
Acupuncture using the above protocol may contribute to reduced xerostomia
for patients with refractory xerostomia after radiotherapy. This technique
did not produce adverse effects and is considerably less expensive than
pharmacological alternatives. Longer follow-up, optimization of technique,
and further prospective objective measurement of saliva response continue
in our clinic. Further research is imperative to optimize acupuncture
techniques for head and neck cancer patients.
REFERENCES
1. Auriculotherapy Manual. Tulsa, Okla: Electro-Therapy Association;
1996.
2. Oleson TD. Auriculotherapy Manual: Chinese and Western Systems
of Ear Acupuncture. 2nd ed. Los Angeles, Calif: Health Care Alternatives;
1996:56, 113.
3. Helms JM. Acupuncture Energetics: A Clinical Approach for
Physicians. Berkley, Calif: Medical Acupuncture Publishers; 1995:684.
AUTHORS'
INFORMATION
Dr Richard Niemtzow is a Colonel in the United States Air Force (USAF),
on loan to the U.S. Navy for a special acupuncture project. Dr Niemtzow
is the first physician practicing acupuncture full-time at the Naval
Medical Center in San Diego, California, with special interest in oncology
patients.
Richard C. Niemtzow,
MD, PhD, MPH*
1835 E. Main St.
El Cajon, CA 92021-5255
Phone: 619-447-6806 o Fax: 619-447-6881
E-mail: N5EV@aol.com
All authors,
Bryon C. May, MD, Y. Peter Peng, MD,
Warren S. Inouye, MD, Peter A. Johnstone, MD, MA, may be contacted at:
Radiation Oncology Division
Naval Medical Center
34800 Bob Wilson Dr., Suite 14
San Diego, CA 92134-1014
*Correspondence
and reprint requests to: Dr Richard C. Niemtzow, Radiation Oncology
Division, Naval Medical Center, 34800 Bob Wilson Dr., Suite 14, San
Diego, CA 92134-1014. Phone: 619-532-7274; Fax: 619-532-8178; E-mail:
N5EV@aol.com.
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