Two- Versus Four-Times Weekly Acupuncture-Like Transcutaneous Electrical Nerve Stimulation for Treatment of Radiation-Induced Xerostomia: A Pilot Study

Abstract

Background: Xerostomia occurs in the majority of patients undergoing chemoradiation therapy for head and neck cancer (HNC). Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) treatment has been studied as an encouraging modality to improve salivary function and related symptoms. The purpose of this study was to compare ALTENS treatment by using a four-times weekly schedule for 6 weeks versus a twice-weekly schedule for 12 weeks with a validated xerostomia scale at 15 months from the start of ALTENS treatment. Materials and Methods: This single-center randomized study was conducted in 30 patients treated with radiotherapy with or without chemotherapy for HNC between 2014 and 2017, who had at least grade 1 or 2 symptomatic dry mouth (xerostomia) according to CTEP NCI Common Terminology Criteria for Adverse Events (CTCAE version 4.0). These patients were randomly assigned to receive ALTENS four-times weekly for 6 weeks or two-times weekly for 12 weeks. The University of Michigan 15-item Xerostomia-related Quality of Life Scale (XeQoLS) was administered at 6, 9, 15, and 21 months from the start of ALTENS treatment. A random-effects generalized linear model was used to model the overall XeQoLS score at the 15-month endpoint; adjusted for a random time effect, a fixed treatment arm, and interaction of time and treatment. Comparison between arms was based on a 0.05 nominal significance level. Results: XeQoLS decreased for all patients (although not statistically for each arm) from a mean of 22 and 21 at baseline (in the four times per week and twice weekly arms) to 12 in both arms at 15 months, with no difference between arms (p = 0.68). There were no attributable grade 1-3 adverse events. Arms were balanced for age, gender, race, and baseline xerostomia. Conclusions: This study demonstrates that both ALTENS regimens are safe, well tolerated, and appear to be equally effective. We now routinely make ALTENS units available for home use.

Acupuncture for radiation-induced toxicity in head and neck squamous cell carcinoma: a systematic review based on PICO criteria

“…In spite of the methodological rigorousness based on a PICO-literature search, the large heterogeneity found in the retrieved data restrained us from providing any definitive recommendation on the role of acupuncture in the field of HNSCC. We acknowledge that focusing on papers published in languages other than English (i.e., Chinese) may represent a limitation of our study, as well as the exclusion of results obtained with ALTENS [89][90][91].…”

Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello

“…Cuando la capacidad secretora residual de las glándulas salivales aún está presente, puede ser apropiada la estimulación de la secreción salival 46 . Entre las opciones reportadas en la literatura están los fármacos parasimpaticomiméticos, la acupuntura, la fitoterapia, la estimulación nerviosa y la PBMT 38,[45][46][47][48][49][50][51][52][53][54][55][56][57][58] .…”

“…Existen dos tipos de TENS: la TENS convencional que consiste en la estimulación local de las glándulas salivales y la TENS similar a la acupuntura que consiste en la estimulación a distancia 53,54 . Estudios han demostrado que ambos tipos de TENS son eficaces y seguros para disminuir la xerostomía inducida por radioterapia 55,56 .…”

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

“…A total of 58 RCTs met eligibility criteria and, together with the 2010 systematic reviews, 26,27 form the evidentiary basis for the guideline recommendations. [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86] A QUOROM flow diagram is provided in the Data Supplement. The identified trials included 46 preventive studies and 12 therapeutic studies.…”

“…A second RCT 85 (N = 148) compared acupuncture-like transcutaneous stimulation (ALTENS) with pilocarpine for relieving radiation-induced xerostomia in patients with head and neck cancer showing no significant difference between the two groups. The third RCT 53 (N = 30) compared two different schedules for ALTENS treatment (four-times weekly for 6 weeks versus a twice-weekly schedule for 12 weeks) showing no significant difference between the two schedules.…”