随机对照试验研究针灸预防鼻咽癌放疗后口干症。
Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma.
机构信息
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
出版信息
Cancer. 2012 Jul 1;118(13):3337-44. doi: 10.1002/cncr.26550. Epub 2011 Nov 9.
BACKGROUND
Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients, and available treatments are of little benefit. The objective of this trial was to determine whether acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy.
METHODS
A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3×/wk on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates. Patients were followed for 6 months after the end of radiotherapy.
RESULTS
Xerostomia Questionnaire scores for acupuncture were statistically significantly lower than for controls starting in week 3 through the 6 months (P = .003 at week 3, all other P < .0001), with clinically significant differences as follows: week 11, relative risk (RR) 0.63 (95% confidence interval [CI], 0.45-0.87); 6 months, RR 0.38 (95% CI, 0.19-0.76). Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (unstimulated whole salivary flow rate, P = .0004), with greater saliva flow in the acupuncture group at week 7 (unstimulated whole salivary flow rate, P < .0001; stimulated whole salivary flow rate, P = .002) and 11 (unstimulated whole salivary flow rate, P < .02; stimulated whole salivary flow rate, P < .03) and at 6 months (stimulated whole salivary flow rate, P < .003).
CONCLUSIONS
Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.
背景
头颈部放疗后出现口干（口腔干燥）是癌症患者的常见问题，而现有的治疗方法收效甚微。本试验旨在确定针刺疗法是否可以预防头颈部放疗患者发生口干。
方法
本研究为一项随机对照试验，纳入了复旦大学附属肿瘤医院的鼻咽癌患者，比较了针刺与标准护理的效果。共 40 例患者接受针刺治疗，46 例患者接受标准护理。患者在放疗期间的同一日，每周接受 3 次针刺治疗。主观测量包括口干问卷和 MD 安德森头颈部症状评估量表（MDASI-HN）。客观测量包括非刺激和刺激全唾液流速。患者在放疗结束后随访 6 个月。
结果
从第 3 周到 6 个月，针刺组的口干问卷评分均显著低于对照组（第 3 周时 P =.003，其余所有时间 P <.0001），差异具有临床意义：第 11 周时，相对危险度（RR）为 0.63（95%置信区间 [CI]，0.45-0.87）；6 个月时，RR 为 0.38（95% CI，0.19-0.76）。MDASI-HN 评分也有类似的发现。从治疗开始后 3 周，唾液组的组间差异就已经显现（非刺激全唾液流速，P =.0004），针刺组在第 7 周（非刺激全唾液流速，P <.0001；刺激全唾液流速，P =.002）和第 11 周（非刺激全唾液流速，P <.02；刺激全唾液流速，P <.03）以及 6 个月时（刺激全唾液流速，P <.003）的唾液流量更大。
结论
放疗同时进行针刺治疗可显著减轻口干症状，改善生活质量。
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