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acupuncture:evaluation:oncologie:03. xerostomie post-radique [24 Mar 2022 06:34] Nguyen Johan [1. Systematic Reviews and Meta-Analysis] |
acupuncture:evaluation:oncologie:03. xerostomie post-radique [28 Aug 2025 19:31] (Version actuelle) Nguyen Johan [1.1. Gu 2025] |
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| - | /*English:Radiation-Induced Xerostomia*/http://www.wiki-mtc.org/doku.php?id=acupuncture:evaluation:oncologie:03.%20xerostomie%20post-radique&do=edit&rev=1608298412 | + | /*English:Radiation-Induced Xerostomia*/ |
| ====== Radiation-Induced Xerostomia ====== | ====== Radiation-Induced Xerostomia ====== | ||
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| ===== Systematic Reviews and Meta-Analysis ===== | ===== Systematic Reviews and Meta-Analysis ===== | ||
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| + | ==== Gu 2025 ==== | ||
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| + | Gu W, Dong H, Yuan Y, Yuan Z, Jiang X, Qian Y, Shen Z. Is Acupuncture an Effective Treatment for Radiation-Induced Xerostomia of Patients with Head and Neck Cancer? A Systematic Review and Meta-Analysis. J Integr Complement Med. 2025 May;31(5):431-444. https://doi.org/10.1089/jicm.2023.0781 | ||
| + | ^Backgound| Radiation-induced xerostomia (RIX) stands out as one of the most severe side effects among patients with head and neck cancer (HNC). Given the varied conclusions in previous studies concerning the association between acupuncture, sham acupuncture, or acupuncture combined with standard oral care and therapeutic effects, our aim is to conduct a systematic review to assess the effectiveness and safety of acupuncture in managing RIX in patients with HNC. | | ||
| + | ^Methods| Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Chongqing VIP, and WanFang Database) were electronically searched, following the Cochrane manual and adhering to reported Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, from their inception dates to July 1, 2024. Primary randomized clinical trials included in systematic reviews or meta-analyses were identified, with the Xerostomia Questionnaire and Xerostomia Inventory designated as the primary outcomes. Salivary flow rates (unstimulated or stimulated) were defined as secondary outcomes. | | ||
| + | ^Results|**Eight clinical trials involving 1273 participants** were analyzed, with six studies included in the meta-analysis. The results indicate that acupuncture demonstrated a significant improvement in patient-reported xerostomia scores (standardized mean difference [SMD] = -0.20, 95% confidence interval [95% CI] [-0.38, -0.02], I2 = 0%) in comparison to standard care, but did not significantly improve oral dryness symptoms compared with sham acupuncture (SMD = -0.06, 95% CI [-0.29, 0.16], I2 = 25.8%). The merged total showed negative result (SMD = -0.13, 95% CI [-0.27, 0.01], I2 = 8.2%). Additionally, there was no significant difference in stimulated salivary flow rate (SMD = -0.22, 95% CI [-0.58, 0.13], I2 = 0%) and unstimulated salivary flow rate (SMD = -0.19, 95% CI [-0.11, 0.72], I2 = 67.2%). In general, the acupuncture did not cause serious adverse effects.| | ||
| + | ^ Conclusion| As far as current research is concerned, acupuncture treatment for RIX symptoms in patients with HNC still lacks strong and convincing evidence support. The more scientific research methods and more clinical trials are still needed.| | ||
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| + | ==== Mercadante 2025 ==== | ||
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| + | Mercadante V, Smith DK, Abdalla-Aslan R, Andabak-Rogulj A, Brennan MT, Jaguar GC, Clark H, Fregnani E, Gueiros LA, Hovan A, Kurup S, Laheij AMGA, Lynggaard CD, Napeñas JJ, Peterson DE, Elad S, Van Leeuwen S, Vissink A, Wu J, Saunders DP, Jensen SB. A systematic review of salivary gland hypofunction and/or xerostomia induced by non-surgical cancer therapies: prevention strategies. Support Care Cancer. 2025 Jan 10;33(2):87. https://doi.org/10.1007/s00520-024-09113-x | ||
| + | ^Purpose| This systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies.| | ||
| + | ^Methods| Electronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article.| | ||
| + | ^Results| A total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive **acupuncture** showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions.| | ||
| + | ^Conclusion| This systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including **acupuncture** and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs.| | ||
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| + | ==== Tsai 2025 ==== | ||
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| + | Tsai RY, Lin SY, Chen CC, Hsiao Y. Efficacy of Acupuncture in Managing Radiation-Induced Xerostomia: An Updated Meta-Analysis. Int J Med Sci. 2025 May 31;22(11):2802-2815. https://doi.org/10.7150/ijms.110366 | ||
| + | ^Backgound| Xerostomia, or dry mouth, frequently affects head and neck cancer patients receiving radiotherapy, leading to discomfort and impacting daily functions such as speaking and swallowing. Conventional treatments may offer limited relief and are often accompanied by undesirable side effects. Acupuncture, as a non-pharmacological intervention, is increasingly explored for its potential to mitigate xerostomia symptoms. | | ||
| + | ^Objective| This systematic review and meta-analysis aim to assess the effectiveness of acupuncture in improving symptoms and quality of life in patients experiencing radiation-induced xerostomia. | | ||
| + | ^Methods| A thorough literature search was conducted across several databases, including MEDLINE, Embase, Cochrane Central, and Web of Science, up to the current year. We included randomized controlled trials (RCTs) that evaluated acupuncture's impact on salivary flow and symptom relief in adults with radiation-induced xerostomia. Primary outcomes were changes in salivary flow, with secondary outcomes including patient-reported symptom severity and quality of life metrics. The risk of bias was evaluated, and data were synthesized using a random-effects model. | | ||
| + | ^Results| A total of **11 RCTs involving 1271 participants** were included in the analysis. The pooled data showed a moderate increase in salivary flow in the acupuncture group, effective in both resting and stimulated conditions. Additionally, acupuncture demonstrated significant benefits in reducing xerostomia symptoms and improving quality of life scores compared to control interventions. Subgroup analysis revealed that traditional acupuncture was more effective than Transcutaneous Electrical Nerve Stimulation (TENS). | | ||
| + | ^Conclusions| The findings suggest that acupuncture may be an effective complementary treatment for radiation-induced xerostomia, offering relief from dry mouth symptoms and potentially improving quality of life. Further research should focus on standardizing acupuncture protocols to confirm these benefits across diverse patient populations.| | ||
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| + | ==== Khamdi 2024 ==== | ||
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| + | Khamdi S, Matangkasombut O, Lam-Ubol A. Non-pharmacologic interventions for management of radiation-induced dry mouth: A systematic review. Oral Dis. 2024 Jul;30(5):2876-2893. https://doi.org/10.1111/odi.14804 | ||
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| + | ^Objectives|Radiation-induced dry mouth negatively impacts patients' oral health and quality of life. Currently, evidence-based recommendation for non-pharmacologic interventions is still lacking. This study aimed to systematically review clinical trials evaluating the efficacy of non-pharmacologic interventions in cancer patients with radiation-induced dry mouth.| | ||
| + | ^Methods|Randomized controlled trials from 2000 were searched from 4 databases, including MEDLINE, Cochrane, Embase via OVID, and SCOPUS, up to December 16th, 2022 (PROSPERO registration CRD42022378405). The risk of bias was assessed using the revised Cochrane risk of bias assessment tool.| | ||
| + | ^Results|Twenty-one studies were included: 11 on artificial saliva, 4 on electrical nerve stimulation (TENS), **2 on acupuncture**, and one study each on low-level laser therapy, stem cells, chewing gum, and probiotics. Overall bias was low, medium, and high in 33%, 48%, and 19% of the studies, respectively. Certain artificial saliva products and TENS were shown to improve dry mouth symptoms and salivary flow rate (SFR). One study showed that stem cell transplantation significantly increased SFR.| | ||
| + | ^Conclusions|The evidence suggested that certain artificial saliva products and TENS are promising management. However, the evidence was still limited due to heterogeneity of interventions and outcome measurements. Thus, future studies using standard measurements and long-term follow-up are warranted.| | ||
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| ==== Bonomo 2022 ==== | ==== Bonomo 2022 ==== | ||
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| + | ===== Overview of systematic reviews ===== | ||
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| + | ==== Hubner 2022 Ø ==== | ||
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| + | Hubner J, Dorfler J, Freuding M, Zaiser C, Buntzel J, Keinki C, Käsmann L. Methodological Review: Summary of Findings for Acupuncture as Treatment for Cancer Therapy-induced Xerostomia. In Vivo. 2022 Nov-Dec;36(6):2579-2597. https://doi.org/10.21873/invivo.12993 | ||
| + | ^Background/aim| With a rapidly growing number of studies, systematic reviews (SRs) and meta-analyses (MAs) on acupuncture, the level of evidence seems to be high. Yet, traditional Chinese acupuncture is built on concepts which are not in accordance with science-based medicine. Accordingly, our aim was to critically assess the evidence presented in SRs and MAs on xerostomia induced by treatment of head and neck cancer with radiotherapy.| | ||
| + | ^Materials and Methods| In February 2022, a systematic search of five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) was conducted to find SRs/MAs on acupuncture use against cancer-treatment induced xerostomia. We evaluated all SRs/MAs using the AMSTAR instrument, comparing the assessment of the individual studies included and the conclusions drawn by the authors. In case of heterogeneity between the SRs, we evaluated the controversial items of the assessments directly from the studies.| | ||
| + | ^Results|Finally, **eight SRs/Mas** were included. Most of them show methodological drawbacks in several domains of the AMSTAR instrument, which influences the credibility of the results.| | ||
| + | ^Conclusion|The evidence on the use of acupuncture as treatment for radiotherapy-induced xerostomia is low. Present SRs/MAs mainly summarize results of a few and mostly small studies. Even though the included studies greatly overlap, the quality of the presentation and interpretation of the authors differs greatly. Therefore, a high quality and conclusive summary of the present evidence on the use of acupuncture to treat radiotherapy induced xerostomia is still missing.| | ||
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| + | ==== Multinational Association of Supportive Care in Cancer (MASCC) and the International Society of Oral Oncology (ISOO) 2024 Ø==== | ||
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| + | Hong C, Jensen SB, Vissink A, Bonomo P, Santos-Silva AR, Gueiros LA, Epstein JB, Elad S. MASCC/ISOO Clinical Practice Statement: Management of salivary gland hypofunction and xerostomia in cancer patients. Support Care Cancer. 2024 Jul 25;32(8):548. https://doi.org/10.1007/s00520-024-08688-9 | ||
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| + | |There are a few randomized controlled trials evaluating the use of **acupuncture**, photobiomodulation , salivary gland ductal irrigation/dilation in alleviating salivary gland hypofunction and/or xerostomia. However, the recommendation for their routine use in the clinical setting is premature mainly because of conflicting evidence and the heterogeneities in treatment protocols.| | ||
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| + | ==== Association of the Scientific Medical Societies, German Cancer Society, German Cancer Aid, (AWMF, DKG, DK, Germany) 2021 ⊕ ==== | ||
| + | S3-Leitlinie Komplementärmedizin in der Behandlung von onkologischen PatientInnen. September 2021. | ||
| + | https://www.leitlinienprogramm-onkologie.de/leitlinien/komplementaermedizin/ | ||
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| + | | 11.3.1.14. Xerostomia. Acupuncture. Recommendation strength: Can. Patient context: Patients with head and neck tumors. Note: During radio/chemotherapy. **Acupuncture**. Recommendation strength: Can. Patient context: Oncological patients .Note: Xerostomia after adjuvant radiotherapy.| | ||
| ==== Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) / American Society of Clinical Oncology (ASCO, USA) 2021 ⊕ ==== | ==== Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) / American Society of Clinical Oncology (ASCO, USA) 2021 ⊕ ==== | ||
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| |Recommendation 1.3. Acupuncture may be offered during radiation therapy for head and neck cancer to reduce the risk of developing xerostomia (type: evidence-based; evidence quality: intermediate; strength of recommendation: moderate). \\ Recommendation 2.4. Acupuncture may be offered after radiation therapy in patients with head and neck cancer for improvement of xerostomia (type: evidence-based; evidence quality: low; strength of recommendation: weak). \\ Recommendation 2.5. Transcutaneous electrostimulation or acupuncture-like transcutaneous electrostimulation of the salivary glands may be offered after radiation therapy in patients with head and neck cancer for improvement of salivary gland hypofunction and xerostomia (type: evidence-based; evidence quality: low; strength of recommendation: weak). | | |Recommendation 1.3. Acupuncture may be offered during radiation therapy for head and neck cancer to reduce the risk of developing xerostomia (type: evidence-based; evidence quality: intermediate; strength of recommendation: moderate). \\ Recommendation 2.4. Acupuncture may be offered after radiation therapy in patients with head and neck cancer for improvement of xerostomia (type: evidence-based; evidence quality: low; strength of recommendation: weak). \\ Recommendation 2.5. Transcutaneous electrostimulation or acupuncture-like transcutaneous electrostimulation of the salivary glands may be offered after radiation therapy in patients with head and neck cancer for improvement of salivary gland hypofunction and xerostomia (type: evidence-based; evidence quality: low; strength of recommendation: weak). | | ||
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| + | ==== Association of the Scientific Medical Societies, German Cancer Society, German Cancer Aid, (AWMF, DKG, DK, Germany) 2020 ⊕ ==== | ||
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| + | Supportive Therapie bei onkologischen PatientInnen. Leitlinienprogramm Onkologie. Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF. 2020. [219443]. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Supportivtherapie/LL_Supportiv_Langversion_1.3.pdf | ||
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| + | |//Xerostomia//. The prophylactic use of classical **acupuncture** therapy improves subjective and objective parameters of radiogenic xerostomia. It can be used. **Acupuncture** can improve the subjective parameters of xerostomia and can be used.| | ||
| ==== Association Francophone des Soins Oncologiques de Support (AFSOS, France) 2014 ⊕ ==== | ==== Association Francophone des Soins Oncologiques de Support (AFSOS, France) 2014 ⊕ ==== | ||
