Acupuncture for radiation-induced toxicity in head and neck squamous cell carcinoma: a systematic review based on PICO criteria

Abstract

Purpose In head and neck squamous cell carcinoma (HNSCC), the potential mitigating effect of complementary medicine interventions such as acupuncture for radiation-induced toxicity is unknown. This study aimed to assess the impact of acupuncture on the incidence and degree of severity of common radiation-induced side effects. Methods In accordance with pre-specified PICO criteria, a systematic review was performed. Two electronic databases (Medline and Embase) were searched over a 10-year time frame (01/01/10 to 30/09/20). Patients undergoing a curatively intended, radiation-based treatment for histologically confirmed squamous cell carcinoma of the nasopharynx, oropharynx, larynx, hypopharynx and oral cavity represented the target population of our study. Accurate information on the acupuncture methodology was reported. All included articles were evaluated to identify any potential source of bias Results Five papers were included in our qualitative analysis, for a total of 633 subjects. Compliance to per-protocol defined schedule of acupuncture sessions was high, ranging from 82 to 95.9%. Most patients (70.6%) were randomly allocated to receive acupuncture for its potential preventive effect on xerostomia. The large heterogeneity in study settings and clinical outcomes prevented from performing a cumulative quantitative analysis, thus no definitive recommendations can be provided. Conclusions Although shown to be feasible and safe, no firm evidence currently supports the use of acupuncture for the routine management of radiation-induced toxicity in HNSCC.

Methodological Review: Summary of Findings for Acupuncture as Treatment for Cancer Therapy-induced Xerostomia

“…The methodological quality was assessed with the AMSTAR-2 instrument for SRs or meta-analyses (8). The AMSTAR contains 16 items, covering the most important quality aspects in an SR. Only three out of the eight included SRs conducted a MA and could therefore be assessed in this category (Item 11,12,and 15). Except for one (19), all SRs showed deficiencies in at least one domain of the AMSTAR-2, with one showing deficiencies in seven domains (20).…”

“…(2017) (20) presented the full search string (13,19), gave the information to send the full string on request (22) or gave the terms they used (11,12,21,23). Still, none of the SRs fulfilled all criteria to entirely comply with this AMSTAR-item.…”

“…Still, none of the SRs fulfilled all criteria to entirely comply with this AMSTAR-item. Drawbacks included not conducting further searches in reference lists (21,22), grey literature (or explain, why this is not necessary) (11-13, 19-21, 23), in trial/ study registers (11,12,(20)(21)(22)(23) or not contacting experts in the field (11)(12)(13)(19)(20)(21)(22)(23).…”

“…Only two SRs provided a list of excluded studies after the full-text screening (19,22), while one cites the excluded studies in the description of the method section (12). Most SRs only mentioned the number of studies excluded and reasons for exclusion in the text but did not list the respective references (11,13,21,23) and Mercandante et al (2017) gave information in the text (20).…”

Diagnosis, Prevention, and Treatment of Radiotherapy-Induced Xerostomia: A Review

“…Second, acupuncture has a direct effect on SG blood flow [ 119 ]. However, most studies on acupuncture have significant heterogeneity and low comparability [ 120 ].…”