Acupuncture for the relief of odynophagia and xerostomia after chemoradiation therapy in oropharyngeal cancer: a case report

© 2013 Wu et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Head and neck cancer accounts for approximately 3 percent of all cancers in the United States. Over 52,000 people in the United States are expected to be diagnosed with head and neck cancers in 2012 [1]. Treatment of head and neck cancer commonly involves radiotherapy, with or without concomitant chemotherapy [2]. Radiation therapy damages the mucosa and soft tissue within the radiation treatment volume, resulting in an inflammatory reaction and the production of reactive oxygen species [3]. Odynophagia (painful swallowing) and xerostomia (lack of saliva) are common side effects following chemoradiation therapy in head and neck cancer. Xerostomia is the most frequent complication reported after head and neck radiotherapy; however, odynophagia is considered as the most detrimental component of quality of life [4]. Tissue swelling, odynophagia, and xerostomia all contribute to dysphagia. Odynophagia secondary to radiation-induced mucositis typically resolves within 3 weeks of cessation of chemoradiation in most patients [5]. Current standard treatment options for odynophagia include topical and systemic analgesics (opioid and nonopioid). There is limited data on the effectiveness of these agents for pain relief in patients with head and neck cancer following chemoradiation therapy. The use of opioid analgesics can produce common adverse effects such as constipation, sedation, nausea and vomiting. Current standard treatment options for xerostomia include saliva substitutes and stimulating agents, such as pilocarpine hydrochloride (a cholinergic agonist). However, saliva substitutes are generally ineffective and drugs other than pilocarpine have provided no proven clinical benefit [6]. The reported response rate for pilocarpine is 31%-54% [6]. Acupuncture has long been used for a variety of medical problems, and is considered a relatively safe modality [7]. It has been found in previous studies to be effective in reducing dysphagia symptom severity in head and neck cancer patients [8-11]. Acupuncture has also been found in previous studies to be effective in stimulating saliva and improving xerostomia [12-16]. Abstract Objectives/Case description: A 48 year old male presented with 6-month history of odynophagia and xerostomia, which began during chemotherapy (cetuximab) and radiation therapy (66 Gray in 33 fractions) for treatment of clinical stage T1N1M0 squamous cell carcinoma of his tongue. Odynophagia was described as aching pain at the base of his tongue that felt like his throat was swollen, and was worse with swallowing. He also reported xerostomia, with associated dysphagia and impaired taste. The patient had failed pilocarpine, Biotene rinse, and speech therapy. Physical examination revealed dry oral mucous membranes and skin hyperpigmentation on the neck, consistent with radiation therapy. The musculoskeletal and neurological exam of the head, neck, and upper extremities were otherwise unremarkable. Methods: He received weekly 20-minute sessions of acupuncture (using combination of manual, auricular, and electro-acupuncture) for 10 sessions. He completed a self-report questionnaire asking about the percentage improvement of his symptoms of pain, dry mouth, difficulty swallowing, taste impairment, insomnia, and anxiety at each session. Results: He reported resolution of odynophagia after 4 acupuncture sessions, with the most dramatic improvement after session #2 (50%) and session #3 (90%). He reported gradual improvement of xerostomia, with 30-40% improvement, over 10 acupuncture sessions. Gradual improvement over 10 acupuncture sessions was noted in symptoms associated with xerostomia, such as ability to swallow (25-30% improvement), and sense of taste (25-30% improvement). Discussion: Odynophagia and xerostomia are common complications after chemoradiation in oropharyngeal cancer, and can be difficult to manage. This case report found that acupuncture was effective in treating odynophagia and xerostomia after chemoradiation in oropharyngeal cancer.