Neurological Effects of Acupuncture to Prevent Radiation-induced Xerostomia

Dry mouth is a common problem in cancer patients who have received radiation treatment to the
head and neck. Acupuncture is a technique that may treat symptoms by inserting very thin,
solid, sterile, stainless steel needles into the skin at specific points.

Study Groups:

If you are found to be eligible to take part in this study, you will be randomly assigned (as
in the flip of a coin) into 1 of 2 groups. You will have an equal chance of being in either
group.

Group 1 will receive one type of acupuncture for one session and another type of acupuncture
for the second session.

Group 2 will receive one type of acupuncture for one session and another type of acupuncture
for the second session.

You will not know if you are assigned to Group 1 or Group 2.

Study Visits:

Your acupuncture treatments will be within 3 to 7 days of each other during Weeks 3-5 of your
regularly scheduled radiotherapy visits. It should take about 20 minutes to complete the
acupuncture session each time.

At each acupuncture session, you will complete 3 questionnaires before each session that ask
about dry mouth, any other symptoms you may be having, and your treatment expectations. It
should take about 5 minutes total to complete these questionnaires. You will also complete
another brief questionnaire about dry mouth after each session. It should take about 1 minute
to complete this questionnaire.

You will also have an EEG at each acupuncture treatment. The EEG will be recorded 5 minutes
before acupuncture, during acupuncture, and for 5 minutes after acupuncture. Total visit time
will last about 45-60 minutes.

You will give a saliva sample before and after each acupuncture treatment to measure the
amount of saliva produced.

Length of Study:

You will remain on study for about 1 week. Your participation in the study will be over after
you complete the dry mouth questionnaire after your second acupuncture session.

This is an investigational study.

Up to 50 patients will take part in this multicenter study. Up to 30 will be enrolled at MD
Anderson.

Inclusion Criteria:

1. 18 years of age and be able to give informed consent.

2. Diagnosed with head and neck cancer, which will be primarily nasopharyngeal, and
scheduled to undergo IMRT or proton with or without concurrent chemotherapy at MD
Anderson or Fudan University.

3. Treatment plan that includes external beam radiation at a mean dose of at least 24 Gy
or more to one of the parotid glands (the other gland can receive less than 24 Gy).

4. Anatomically intact parotid and submandibular glands.

5. Karnofsky performance status > 60.

6. Must be right-handed.

Exclusion Criteria:

1. History of xerostomia prior to head and neck radiation therapy or history of Sjögren's
disease or another underlying systemic illness known to cause xerostomia.

2. Prior head and neck radiation treatment.

3. Suspected or confirmed physical closure of salivary gland ducts on either side.

4. Known bleeding disorders or taking any dose of warfarin or heparin.

5. Upper or lower extremity deformities (ie, missing limbs or scars that prevent needle
insertion at the acupuncture points) that could interfere with accurate acupoint
location or alter the energy pathway as defined by traditional acupuncture theory.

6. Local skin infections at or near the acupuncture sites or are under treatment for
active systemic infection.

7. History of cerebrovascular accident or spinal cord injury since the mechanism of
acupuncture may be associated with central nervous system activity.

8. Documented history of mental incapacitation or significant emotional or psychiatric
disorder (i.e. bipolar, schizophrenia) that, in the opinion of the investigator,
precludes study entry as these patients may not be able to cooperate with this
slightly invasive procedure or with the data collection process.

9. Current acknowledged use of any illicit drugs or evidence of alcohol abuse as defined
by The American Psychiatric Association criteria.

10. Patients who are currently receiving acupuncture for any condition or if they have
ever had acupuncture before.