針灸緩解頭頸部癌症放射線治療引起的口乾症


  May 1, 2009 — 根據一篇先驅試驗結果,針灸可以改善放射線引起之口乾症病患的嘴巴乾燥症狀。當以針灸每週治療兩次、為期四週時,接受放射線治療頭頸部癌症的腫瘤病患,生理與生活品質都有顯著改善。
  
  該試驗的結果登載於4月17日的頭頸部期刊,顯示針灸在開始治療後兩週就可以緩解症狀,效果持續到治療結束之後至少一個月。
  
  雖然這是先驅研究,但結果相當令人鼓舞;這些病患在放射線治療產生傷害之後一般很少得以恢復。資深作者、德州大學安德森癌症中心補綴科暨腫瘤牙科主任William Chambers醫師解釋,本研究中的所有病患都達到傷害閾值。他表示,他們都接受超過50 Gy的最後體外放射線治療。
  
  不過,即使病患症狀緩解,在刺激性或者非刺激性唾液分泌上並沒有改變。Chambers醫師向Medscape Oncology表示,唾液分泌並沒有比開始時有統計上的顯著增加,但是有正相關,非刺激性唾液增強[P= .08]。
  
  研究者也指出,個別病患之基礎與唾液分泌率有顯著差異,因此,主觀認知和客觀觀察之間不一定一致。有臨床意義之唾液分泌增加的明確閾值尚未建立,所以即使是少量增加都可以視為病患有緩解。
  
  【主觀症狀有所改善 但客觀上沒有差異】
  本研究中,Chambers醫師等人評估針灸用於緩解19名接受放射線治療之頭頸部癌症病患的口乾症效果。
  
  所有研究對象在開始時以及研究期間都完成口乾症調查以及病患助益問卷;收集唾液分泌的客觀調查與主觀資料,評估未刺激的整體唾液分泌率以及刺激的唾液分泌率。
  
  在第四週和第八週,病患報告症狀有所改善,反映在其口乾症調查以及病患助益問卷結果。根據口乾症調查,平均反應率為40%,在第四週治療結束之後,44.4%達到部份反應。第八週時,此一比率增加到55.6%。
  
  與主觀測量不同,開始時與追蹤期間結束時(第八週)的未刺激整體唾液分泌率或刺激唾液分泌率都無差異。在針灸治療後一週,未刺激整體唾液分泌率以及刺激唾液分泌率都有小量提升。
  
  【需要更大型的試驗確認病患利益】
  Chambers醫師解釋,即使現有的測量工具無法量化,仍顯示有明顯的病患助益,唾腺分泌微小的改變都可以增加口腔舒適度。
  
  某些病患的這些結果也可能是安慰劑效應。不過,研究者指出,嚴重唾腺輻射的病患在四個月之後並無自發性改善,所以本試驗所見的改善比較可能是針灸治療的結果而非自發性恢復。
  
  研究中的所有病患都沒有發生與治療相關的副作用,針灸導致的併發症很罕見。根據病患緩解以及相對安全的這些事實,Chambers醫師認為可以考量用針灸於此類病患。只要病患有興趣且瞭解這些是初步結果。
  
  需要更大型的安慰劑控制試驗,以獲得最後的結果,研究者寫道,他們計畫在未來進行這些試驗,而本計畫是確認之前研究結果的第一步。
  
  Head Neck. 於印刷前線上登載於2009年4月17日。
  

Acupuncture Relieves Radiation-Induced Xerostomia in Head and Neck Cancer

By Roxanne Nelson
Medscape Medical News

May 1, 2009 — Acupuncture can improve subjective symptoms of dry mouth in patients with radiation-induced xerostomia, according to the results of a pilot trial. When treated twice a week for 4 weeks with acupuncture, oncology patients who received radiation treatments to the head and neck area reported significant improvements in physical well being and quality of life.

The results of the trial, published online April 17 in Head & Neck, showed that acupuncture relieved symptoms as early as 2 weeks after starting therapy, with the benefits lasting for at least 1 month after treatment ended.

Although this was a pilot study, the results appear quite encouraging; little or no recovery is generally seen in these patients after they reach the damaging threshold of radiation. But all patients in this study had reached the damaging threshold, explained senior author William Chambers, DMD, MS, chief of the Section of Oncologic Dentistry and Prosthodontics at the University of Texas MD Anderson Cancer Center in Houston. "They all received over 50?Gy of definitive external-beam radiation therapy," he said.

However, the data did not find a change in measured stimulated or unstimulated salivary flow, even though the patients reported symptom relief. "There was no statistically significant increase in saliva flow from baseline, but there was a positive trend, with a spike for unstimulated saliva [P?= .08]," Dr. Chambers told Medscape Oncology.

The researchers also note that basal and salivary flow rates vary significantly among individuals, and therefore, subjective perceptions and objective measurements do not always correlate. A definitive threshold of increased saliva output that results in a clear clinical benefit has not been established, so even a small increase can provide relief to the patient.

Improvements Seen in Subjective Symptoms, Not Objective Differences

In this study, Dr. Chambers and colleagues evaluated the efficacy of acupuncture in alleviating xerostomia in 19 patients with head and neck cancer who had undergone radiation treatment.

All study participants completed the Xerostomia Inventory and the Patient Benefit Questionnaire at baseline and then throughout the study period. Objective measurements of salivary flow were collected with the subjective data, and unstimulated whole salivary flow rate and stimulated salivary flow rate were assessed.

At weeks 4 and 8, patients reported symptom improvement, reflected in both the Xerostomia Inventory and the Patient Benefit Questionnaire scores. The mean response rate, measured by the Xerostomia Inventory, was 40%, and at the end of the fourth week of treatment, 44.4% had achieved a partial response. This percentage rose to 55.6% by week 8.

Unlike subjective measures, there were no differences in the unstimulated whole salivary flow rate or the stimulated salivary flow rate between baseline and the end of the follow-up period (week?8). A small elevation in both the unstimulated whole salivary flow rate and the stimulated salivary flow rate was seen 1 week after acupuncture treatment.

Patient Benefit Seen, Larger Trials Needed

It appears that there was a clear clinical benefit to patients, even if it could not be quantified using current measuring tools, explained Dr. Chambers, and even small changes in salivary flow can result in increased oral comfort.

It is also possible that the results could be attributed to a placebo effect, at least in some patients. However, the researchers do note that patients who have had major salivary glands irradiated do not spontaneously improve after 4 months, so the improvements in this trial "were most likely attributable to the acupuncture treatment rather than spontaneous recovery."

None of the patients in the study experienced adverse events related to their treatment, and complications resulting from acupuncture are rare. Based on the relative safety of the procedure and the fact that patients experienced relief, Dr. Chambers feels that acupuncture is an intervention that can be considered for this population. "As long as patients are interested and understand these results are preliminary," he said.

Larger placebo-controlled trials are needed for more definitive results, and the researchers write that they plan on conducting these trials in the future, but this project is a "first step in verifying promising reports from previous research."

Head Neck. Published online before print April 17, 2009.

    
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