Leucopénie induite par chimiothérapie ou radiothérapie : évaluation de l'acupuncture

Articles connexes: - évaluation de la pharmacopée chinoise - conduites thérapeutiques - pathologie - acupuncture expérimentale - qigong -

1. Revues systématiques et méta-analyses

1.1. Acupuncture générique

1.1.1. Lu 2007 Ø

Lu W, Hu D, Dean-Clower E, Doherty-Gilman A, Legedza AT, Lee H, Matulonis U, Rosenthal DS. Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials. J Soc Integr Oncol. 2007. 5(1):1-10. [144290].

Objective	Chemotherapy-induced leukopenia and neutropenia are common side effects during cancer treatment. Acupuncture has been reported as an adjunct therapy for this complication. The current study reviewed published randomized controlled trials of acupuncture's effect and explored the acupuncture parameters used in these trials.
Methods	We searched biomedical databases in English and Chinese from 1979 to 2004. The study populations were cancer patients who were undergoing or had just completed chemotherapy or chemoradiotherapy, randomized to either acupuncture therapy or usual care. The methodologic quality of trials was assessed. From 33 reviewed articles, 682 patients from 11 eligible trials were included in analyses. All trials were published in non-PubMed journals from China.
Results	The methodologic quality of these trials was considerably poor. The median sample size of each comparison group was 45, and the median trial duration was 21 days. The frequency of acupuncture treatment was once a day, with a median of 16 sessions in each trial. In the seven trials in which white blood cell (WBC) counts were available, acupuncture use was associated with an increase in leukocytes in patients during chemotherapy or chemoradiotherapy, with a weighted mean difference of 1,221 WBC/muL on average (95% confidence interval 636-1,807; p < .0001).
Conclusion	Acupuncture for chemotherapy-induced leukopenia is an intriguing clinical question. However, the inferior quality and publication bias present in these studies may lead to a false-positive estimation. Meta-analysis based on these published trials should be treated in an exploratory nature only.

1.1.2. Liu 2003 Ø

Liu Bao-Yan, et al. Acupuncture for leucopenia induced by chemotherapy or radiotherapy-a meta-analysis. World Journal of Acupuncture-Moxibustion. 2003. 13(4):35. [126628].

Objective	In the present paper, the authors analyze the academic theses of acupuncture for treatment of leucopenia induced by chemo- or radio-therapy.
Results	A total of 14 theses are retrieved and all written in Chinese. Quantitative meta-analysis is done for 4 studies of dichotomous data and 5 studies of continuous data. Both of them have positive results. Majority of these trials have methodological and/or reporting shortcomings. Overall, the existing evidence supports the value of acupuncture for the treatment of leucopenia induced by chemo- or radio-therapy.
Conclusion	However, the evidence is still not fully convincing. There is an urgent need for well planned, large-scale and multiple-center studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.

1.1.3. Li 2003

Li Xiao-Ping Men Zhen Huang Wen-Xia. [Meta Analysis of Chinese Medicine in Treating Post-Chemotherapeutic Leukopenia]. Shanghai Journal of TCM. 2003;37(8):52. [118824].

1.2. Techniques particulières

1.2.1. Moxibustion

1.2.1.1. Choi 2015 ☆

Choi TY, Lee MS, Ernst E. Moxibustion for the Treatment of Chemotherapy-Induced Leukopenia: A Systematic Review of Randomized Clinical Trials. Support Care Cancer. 2015;23(6):1819-26. [184116].

Objectives	The purpose of this study is to assess the efficacy of moxibustion as a treatment of chemotherapy-induced leukopenia.
Methods	Twelve databases were searched from their inception through June 2014, without a language restriction. Randomized clinical trials (RCTs) were included if moxibustion was used as the sole treatment or as a part of a combination therapy with conventional drugs for leukopenia induced by chemotherapy. Cochrane criteria were used to assess the risk of bias.
Results	Six RCTs with a total of 681 patients met our inclusion criteria. All of the included RCTs were associated with a high risk of bias. The trials included patients with various types of cancer receiving ongoing chemotherapy or after chemotherapy. The results of two RCTs suggested the effectiveness of moxibustion combined with chemotherapy vs. Chemotherapy alone. In four RCTs, moxibustion was more effective than conventional drug therapy. Six RCTs showed that moxibustion was more effective than various types of control interventions in increasing white blood cell counts.
Conclusions	There is low level of evidence based on these six trials that demonstrates the superiority of moxibustion over drug therapies in the treatment of chemotherapy-induced leukopenia. However, the number of trials, the total sample size, and the methodological quality are too low to draw firm conclusions. Future RCTs appear to be warranted.

2. Recommandations de bonne pratique

⊕ recommandation positive (quel que soit le niveau de preuve annoncé)
Ø recommandation négative (ou absence de preuve)

2.1. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Allemagne) Ø

Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer. Complementary Therapy Survivorship. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO). 2018.35P. [182073].

Leucopenia. Moxibustion : Level of evidence 2b (individual cohort study), grade of evidence (B), AGO recommendation grade (+/-) This examination or therapeutic intervention has for the patient no advantage shown. It can be done in individual cases. Based on current knowledge, there is currently no general recommendation to be pronounced.

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