In response to What are the best management strategies for radiation-induced xerostomia?

We appreciate Dr. Hopfenspirger’s comments and his interest in our review. We agree that the use of acupuncture is controversial secondary to factors such as a placebo effect and the limited number of participants included in the studies performed to date. However, we do not believe that it is appropriate to deem a randomized controlled trial speculative with any evidence of “efficacy unsupported.” Furthermore, in his critique, Dr. Hopfenspirger fails to note that we proposed a tier-based strategy for treatment in which the first line of therapy is salivary replacement with stringent oral hygiene. Finally, in our concluding paragraph, we state that “further studies in patients with non-nasopharyngeal primaries are indicated to fully delineate the utility of this (acupuncture) therapy.” In sum, in keeping with the mission of the TrioBP, we have provided a tiered evidenced-based approach to the treatment of radiationinduced xerostomia. Perhaps more importantly, by stimulating discussion of potential emerging options, we hope that our review will serve as a foundation on which to advance scientific study. Respectfully,