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Status unknownNCT03336775Updated Jan 21, 2020

Efficacy of Acupuncture in Radiotherapy-induced Dysphagia in Patients With Head and Neck Cancer

An interventional study of acupuncture in Acupuncture, sponsored by Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. Status unknown at 1 site in China. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-01-21.

Sponsored by Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University · Not applicable, Interventional, and Supportive care

The sponsor has not verified this record recently (last verified Jan 2020), so the status shown — last known as Recruiting — may be out of date.
Phase
Not applicable
Study type
Interventional
Enrollment
142
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Purpose:

Rationale: Acupuncture is a therapy for physical activity disorders secondary to nervous diseases, and it may have therapeutic effects on dysphagia caused by radiation therapy.

Purpose: This randomized trial aims to investigate whether acupuncture may alleviate radiation-induced dysphagia in patients with head and neck cancer. The effect was compared with outcomes in patients without receiving acupuncture.

Read the detailed description

OBJECTIVE

Primary:

To determine the therapeutic efficacy of acupuncture on radiotherapy-induced dysphagia in patients with head and neck cancer.

Secondary:

  1. To determine whether acupuncture can improve swallow function in these patients.
  2. To determine what extent acupuncture can improve the complications of dysphagia of these patients, including the incidence of aspiration pneumonia, malnutrition.
  3. To determine what extent this traditional Chinese therapy can improve quality of life of these patients.
  4. To evaluate the safety of acupuncture in these patients.

OUTLINE: This is a randomized study. Patients are randomized to 1 of 2 treatment arms.

Arm I: Patients receive acupuncture for 30 minutes per day for up to 20 sessions (over 4 weeks). These patients also received corticosteroid for 4 weeks, methylprednisolone 80mg ivdrip. for 3 days, 60mg ivdrip. for 3 days, 40mg ivdrip. for 3 days, 30mg po. for 7 days, 20mg po. for 7 days, 10mg po. for 5 days and maintain. Patients undergo VFSS before, at end of therapy (week 4) and 3 months (week 16) after therapy. Swallowing function, outcomes of dysphagia, including incidence of aspiration pneumonia, nutritional status change, and QOL change are assessed at baseline, week 4 and week 16.

Arm Ⅱ: Patients receive corticosteroid only, and the use of corticosteroid is the same with Arm I. Patients undergo VFSS before, at end of therapy (week 4) and 3 months (week 16) after therapy. Swallowing function, outcomes of dysphagia, including incidence of aspiration pneumonia, nutritional status change, and QOL change are assessed at baseline, week 4 and week 16.

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Conditions studied

  • Acupuncture

Keywords

  • acupuncure
  • dysphagia
  • radiation
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Patients must have received radiation therapy for histologically confirmed head and neck cancer;
  2. Prior irradiation >/= 6 months prior to study entry;
  3. Age>/= 18 years;
  4. Routine laboratory studies with bilirubin \</=2 * upper limits of normal (ULN), aspartate aminotransferase (AST or SGOT) \< 2 * ULN, creatinine \<1.5 * ULN, red-cell count >/= 4,000 per cubic millimeter; white-cell count >/=1500 per cubic millimeter, platelets >/= 75,000 per cubic millimeter; PT, APTT, INR in a normal range;
  5. Ability to understand and willingness to sign a written informed consent document, or constant caregivers who well understand and willingness to sign a written informed consent document.

Exclusion criteria

Exclusion Criteria:

  1. Evidence of metastatic disease or tumor recurrence, tumor invasion to major vessels (e.g. the carotid);
  2. Evidence of very high intracranial pressure that suggests brain hernia and need surgery;
  3. History of seizures or bleeding related to tumor or radiotherapy during or after the completion of radiation;
  4. History of coagulation defects or allergy history of contrast agent;
  5. History of disorder that affects swallowing, including brain stroke, oral or throat disease, malignances diseases, infection of the nervous system, demyelinating disease, neurodegenerative disease, advanced dementia, diabetes, peripheral vascular disease, HIV infection, familial degenerative peripheral neuropathy;
  6. Severe complications: 1) New York heart association grade II or greater congestive heart failure; 2) Serious and inadequately controlled cardiac arrhythmia; 3) Significant vascular disease (e.g. aortic aneurysm, history of aortic dissection); 4) Clinically significant peripheral vascular disease; 5) significant uncontrolled life-threatening infection;
  7. Prior use of acupuncture for dysphagia;
  8. Enrolled in other clinical trials.
04

Study design

Phase
Not applicable
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
142 participants (estimated)

Study arms

  • Experimental
    acupuncture

    Patients receive acupuncture for 30 minutes per day for up to 20 sessions (over 4 weeks). These patients also received corticosteroid for 4 weeks, methylprednisolone 80mg ivdrip. for 3 days, 60mg ivdrip. for 3 days, 40mg ivdrip. for 3 days, 30mg po. for 7 days, 20mg po. for 7 days, 10mg po. for 5 days and maintain.

    Procedure: acupuncture

  • No intervention
    control

    Patients receive no acupuncture. The use of corticosteroid is the same with Arm I.

Interventions

  • Procedureacupuncture

    Acupuncture for 30 minutes per day for up to 20 sessions (over 4 weeks).

05

What researchers measure

Primary outcomes

  1. The change of Videofluoroscopic Dysphagia Scale (VDS) from baseline to week 4.

    The change of Videofluoroscopic Dysphagia Scale (VDS) from baseline to week 4. VDS, according to result of Video Fluoroscopy Swallowing Study (VFSS), used as an objective and quantifiable predictor of recovery of the swallowing function. A videofluoroscopic dysphagia scale (VDS) with a sum of 100 was made according to the odds ratios of prognostic factors. The validity of the scale was evaluated by using a receiver operating characteristic curve. The VDS was compiled using the following 14 items: lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of pharyngeal wall, pharyngeal transit time, and aspiration. At a scale cutoff value of 47. The higher the VDS score, the worse the swallowing function.

    Time frame: Assessed at baseline and week 4 during acupuncture treatment.

Secondary outcomes

  1. The change of Videofluoroscopic Dysphagia Scale (VDS) from baseline to week 16.

    The change of Videofluoroscopic Dysphagia Scale (VDS) from baseline to week 16. VDS, according to result of Video Fluoroscopy Swallowing Study (VFSS), used as an objective and quantifiable predictor of recovery of the swallowing function. A videofluoroscopic dysphagia scale (VDS) with a sum of 100 was made according to the odds ratios of prognostic factors. The validity of the scale was evaluated by using a receiver operating characteristic curve. The VDS was compiled using the following 14 items: lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of pharyngeal wall, pharyngeal transit time, and aspiration. At a scale cutoff value of 47. The higher the VDS score, the worse the swallowing function.

    Time frame: Assessed at baseline and 12 weeks post acupuncture treatment.

  2. The change of rosenbek Penetration-Aspiration Scale scores, opening of upper esophageal sphincter(UES) and excursion of hyoid bone from baseline to week 4 and week 16.

    The rosenbek Penetration-Aspiration Scale(PAS) scores, opening of upper esophageal sphincter(UES) and excursion of hyoid bone will be assessed according to the VFSS to objectively evaluate the swallowing function. Penetration defined as passage of the bolus content into the laryngeal vestibule above the vocal cords. When food crossed the vocal cords and entered the airways, it was considered aspiration. Records were taken of the moment aspiration occurred (before onset of pharyngeal swallow, during pharyngeal contraction, or after swallowing). Consideration was also given to the appearance or not of cough during aspiration. Silent aspiration was defined as the entry of food below the level of the true vocal cords, without cough or any outward sign of difficulty. The PAS score with a total of 8, and \>2 is considered to be abnormal. The higher the PAS score, the worse the swallowing function.

    Time frame: Assessed at baseline, week 4 during acupuncture treatment and 12 weeks post acupuncture treatment.

  3. The incidence of aspiration pneumonia change from baseline to week 4 and week 16.

    The incidence of aspiration pneumonia change from baseline to week 4 and week 16.

    Time frame: Assessed at baseline, week 4 during acupuncture treatment and 12 weeks post acupuncture treatment.

  4. The change of nutritional status from baseline to week 4 and week 16.

    The change of nutritional status from baseline to week 4 and week 16. The nutritioanl status include the weight, BMI, albumin.

    Time frame: Assessed at baseline, week 4 during acupuncture treatment and 12 weeks post acupuncture treatment.

  5. The percentage of necessary of nasogastric feeding and gastrostomy from baseline to week 16.

    The percentage of necessary of nasogastric feeding and gastrostomy from baseline to week 16.

    Time frame: Assessed at baseline and 12 weeks post acupuncture treatment.

  6. The change of Quality of Life (QOL) scores from baseline to week 4 and week 16.

    The change of Quality of Life (QOL) scores from baseline to week 4 and week 16. The WHOQOL-BREF instrument comprises 26 items, which measures the following broad domains: physical health, psychological health, social relationships, and environment. The WHOQOL-BREF (Field Trial Version) produces a quality of life profile. It is possible to derive four domain scores. The four domain scores denote an individual's perception of quality of life in each particular domain. Domain scores are scaled in a positive direction (i.e. higher scores denote higher quality of life). The mean score of items within each domain is used to calculate the domain score. Mean scores are then multiplied by 4 in order to make domain scores comparable with the scores used in the WHOQOL-100.

    Time frame: Assessed at baseline, week 4 during acupuncture treatment and 12 weeks post acupuncture treatment.

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Study locations

1 of 1 sites recruiting
  • Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
    Guangzhou, Guangdong 510120, China
    Recruiting
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT03336775
Lead sponsor
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Responsible party
Yamei Tang (Professor, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University) — Principal investigator
First posted
Nov 8, 2017
Start date
Jun 21, 2018
Primary completion
Apr 30, 2020 (estimated)
Completion
Jul 30, 2020 (estimated)
Last update
Jan 21, 2020

Study contacts

Yamei Tang
Contact
yameitang@hotmail.com
+862034070569
yamei tang
study director · Sun Yat-sen Memorial Hospital,Sun Yat-sen University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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