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acupuncture:evaluation:oncologie:03. xerostomie post-radique [28 Aug 2025 19:23] Nguyen Johan [1.1. Khamdi 2024] |
acupuncture:evaluation:oncologie:03. xerostomie post-radique [28 Aug 2025 19:31] (Version actuelle) Nguyen Johan [1.1. Gu 2025] |
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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.| | ||
