title: A Phase I-II study in the use of acupuncture-like transcutaneous nerve stimulation in the treatment of radiation-induced xerostomia in head-and-neck cancer patients treated with radical radiotherapy.
abstract: OBJECTIVE
  Recent studies have suggested that acupuncture may improve radiation-induced xerostomia with an increase in the median salivary flow rate and sustained symptom relief. An acupuncture-like transcutaneous nerve stimulation method (Codetron) without invasive needles was developed to mimic acupuncture treatment. This Phase I-II study examined the effectiveness of Codetron in treating radiation-induced xerostomia.
  
  
  METHODS
  Patients with symptomatic xerostomia after radical radiotherapy for head-and-neck cancer but with evidence of residual salivary function were recruited into the study. Two 6-week courses of Codetron treatment of acupuncture points preselected according to traditional Chinese medicine principles were given with a 2-week break between each course. Basal and citric acid-primed whole saliva production were measured at baseline and up to 1 year after treatment completion. Xerostomia symptoms were assessed by a five-item xerostomia symptom questionnaire with a visual analog scale and quality of life was evaluated using the Head and Neck Radiotherapy Questionnaire.
  
  
  RESULTS
  We enrolled 46 patients in the study. All patients had received radiotherapy doses of >or=50 Gy to bilateral head-and-neck fields, including the parotid glands. Of the 46 patients, 37 completed the follow-up assessments at 3 and 6 months after treatment completion. No Codetron treatment-related complications occurred. Improvement in xerostomia symptoms was noted, with a mean increase in the visual analog scale score of 86 (p < 0.0005) and 77 (p < 0.0001) at 3 and 6 months after treatment completion, respectively. For all patients, the increase in the mean basal and citric acid-primed whole saliva production at 3 and 6 months after treatment completion was also statistically significant (p < 0.001 and p < 0.0001, respectively). No statistically significant change in the quality-of-life evaluation compared with baseline was observed.
  
  
  CONCLUSIONS
  The results suggest that Codetron treatment improves whole saliva production and related symptoms in patients with radiation-induced xerostomia. The treatment effects were sustained for at least 6 months after Codetron treatment completion. A prospective randomized Phase III trial with appropriate controls is being planned.
authors.affiliation: Department of Medicine, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada. raimond.wong@hrcc.on.ca
authors.forename: Raimond K W
authors.initials: RK
authors.lastname: Wong
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Jones
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sagar
authors.forename: Angelica-Fargas
authors.initials: AF
authors.lastname: Babjak
authors.forename: Tim
authors.initials: T
authors.lastname: Whelan
mesh_terms: D015669:Acupuncture Points; D000368:Aged; D000369:Aged, 80 and over; D015671:Electroacupuncture / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000528:radiation effects; D012472:Salivation; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D014987:Xerostomia / Q000209:etiology / Q000628:therapy*