Acupuncture therapy for radiotherapy-induced adverse effect: A systematic review and network meta-analysis

Objective To evaluate the efficacy of different acupuncture therapies for radiotherapy-induced adverse effects (RIAEs) and find out the optimal scheme. Methods Eligible randomized controlled trials (RCTs) were collected from inception to June 2020 from 9 bibliographic databases. The risk of bias evaluation of the analyzed literature was carried out using the Cochrane risk-of-bias tool. Network meta-analysis was mainly performed using STATA 14.2 and OpenBUGS 3.2.3 by figuring out the network diagrams, league figures, and SUCRA values. Results A total of 41 studies with 3,011 participants reported data suitable for network meta-analysis. There was a low to moderate risk of bias in twenty of the articles. ST36 was the most widely prescribed acupoint. Based on network meta-analysis, four outcome indicators were described, namely, acupuncture + medication ranked first in treating radiation enteritis, moxibustion + medication ranked first in preventing radiotherapy-induced leukopenia, acupuncture + medication ranked first in preventing radioactive oral mucositis, and acupuncture ranked first in improving the stimulated salivary flow rate of radioactive xerostomia. Conclusion The findings of the network meta-analysis manifested that acupuncture therapy combined with medication has superiority in most RIAEs, both reducing incidence and relieving symptoms. However, high-quality studies are still needed to provide conclusive evidence. Systematic review registration https://inplasy.com/inplasy-2020-7-0054/, identifier: INPLASY202070054.

[1]  Cun-Zhi Liu,et al.  Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology , 2022, Frontiers in Neuroscience.

[2]  Cheng Peng,et al.  Treatment of Irritable Bowel Syndrome by Chinese Medicine: A Review , 2021, Chinese Journal of Integrative Medicine.

[3]  Cun-Zhi Liu,et al.  Electroacupuncture ameliorates intestinal inflammation by activating α7nAChR-mediated JAK2/STAT3 signaling pathway in postoperative ileus , 2021, Theranostics.

[4]  Chengwei Fu,et al.  Acupuncture therapy for radiotherapy-induced adverse effects: a protocol for systematic review and Bayesian network meta-analysis. , 2021, Annals of palliative medicine.

[5]  Yong Guo,et al.  The Combinatorial Effect of Cisplatin and Moxibustion on Tumor Growth Inhibition with Special Reference to Modulation of the Immune Microenvironment in Lewis Lung Cancer Mice , 2020, Evidence-based complementary and alternative medicine : eCAM.

[6]  F. Liang,et al.  Acupuncture for Radiation-Induced Xerostomia in Cancer Patients: A Systematic Review and Meta-Analysis , 2020, Integrative cancer therapies.

[7]  F. Dastan,et al.  Efficacy and safety of propolis mouthwash in management of radiotherapy induced oral mucositis; A randomized, double blind clinical trial. , 2020, Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology.

[8]  C. Xue,et al.  Radioprotective effects and mechanisms of animal, plant and microbial polysaccharides. , 2020, International journal of biological macromolecules.

[9]  M. Chambers,et al.  Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer , 2019, JAMA network open.

[10]  J. Beyene,et al.  Empirical evaluation of SUCRA-based treatment ranks in network meta-analysis: quantifying robustness using Cohen’s kappa , 2019, BMJ Open.

[11]  A. Vissink,et al.  Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients. , 2019, Journal of the National Cancer Institute. Monographs.

[12]  Yanling Pi,et al.  Effect of acupuncture at ST36 on motor cortical excitation and inhibition , 2019, Brain and behavior.

[13]  B. Purwanto,et al.  Improvement in inflammation and airway remodelling after acupuncture at BL13 and ST36 in a mouse model of chronic asthma , 2019, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[14]  B. Timmermann,et al.  Evolving Radiotherapy Techniques in Paediatric Oncology. , 2019, Clinical oncology (Royal College of Radiologists (Great Britain)).

[15]  Yi Guo,et al.  Current Tracking on Effectiveness and Mechanisms of Acupuncture Therapy: A Literature Review of High-Quality Studies , 2019, Chinese Journal of Integrative Medicine.

[16]  J. Achkar,et al.  Acupuncture in Inflammatory Bowel Disease. , 2018, Inflammatory bowel diseases.

[17]  W. Cho,et al.  Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer. , 2018, The Cochrane database of systematic reviews.

[18]  Haejeong Nam,et al.  Comparison of the effectiveness between transcutaneous electrical nerve stimulation, manual acupuncture, and electroacupuncture on tinnitus: study protocol for a randomized controlled trial , 2018, Trials.

[19]  S. Fedewa,et al.  Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening , 2018, CA: a cancer journal for clinicians.

[20]  Rickey E Carter,et al.  Ranking of the most effective treatments for cardiovascular disease using SUCRA: Is it as sweet as it appears? , 2018, European journal of preventive cardiology.

[21]  D. Stein.  Massage Acupuncture, Moxibustion, and Other Forms of Complementary and Alternative Medicine in Inflammatory Bowel Disease. , 2017, Gastroenterology clinics of North America.

[22]  Jia-yin Liu,et al.  Use of electroacupuncture and transcutaneous electrical acupoint stimulation in reproductive medicine: a group consensus , 2017, Journal of Zhejiang University-SCIENCE B.

[23]  D. Citrin.  Recent Developments in Radiotherapy. , 2017, The New England journal of medicine.

[24]  Nina Yin,et al.  Electro-acupuncture at Acupoint ST36 Ameliorates Inflammation and Regulates Th1/Th2 Balance in Delayed-Type Hypersensitivity , 2017, Inflammation.

[25]  C. Shapiro.  Highlights of Recent Findings on Quality-of-Life Management for Patients With Cancer and Their Survivors. , 2016, JAMA oncology.

[26]  Jaung-Geng Lin,et al.  The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis , 2016, PloS one.

[27]  Hsin-Cheng Hsu,et al.  The History, Mechanism, and Clinical Application of Auricular Therapy in Traditional Chinese Medicine , 2015, Evidence-based complementary and alternative medicine : eCAM.

[28]  C. Taylor,et al.  Cardiac Side-effects From Breast Cancer Radiotherapy. , 2015, Clinics in oncology.

[29]  Yan Liu,et al.  Acupuncture and regulation of gastrointestinal function. , 2015, World journal of gastroenterology.

[30]  K. Soh.  Hypothesis on the Treatment of Gliomas with Acupuncture at the Primo Node Corresponding to Zusanli (ST 36). , 2015, Medical acupuncture.

[31]  Kristian Thorlund,et al.  The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions: Checklist and Explanations , 2015, Annals of Internal Medicine.

[32]  Anurag K. Singh,et al.  Acupuncture-Like Transcutaneous Electrical Nerve Stimulation Versus Pilocarpine in Treating Radiation-Induced Xerostomia: Results of RTOG 0537 Phase 3 Study. , 2015, International journal of radiation oncology, biology, physics.

[33]  A. Bardia,et al.  Patient‐reported outcomes in women with breast cancer enrolled in a dual‐center, double‐blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor‐induced musculoskeletal symptoms , 2014, Cancer.

[34]  Hongyong Deng,et al.  The Mechanism of Moxibustion: Ancient Theory and Modern Research , 2013, Evidence-based complementary and alternative medicine : eCAM.

[35]  H. Worthington,et al.  Interventions for the management of dry mouth: non-pharmacological interventions. , 2013, The Cochrane database of systematic reviews.

[36]  Zhen Chen,et al.  The Preventive and Therapeutic Effect of Acupuncture for Radiation-Induced Xerostomia in Patients With Head and Neck Cancer , 2013, Integrative cancer therapies.

[37]  Yuanyu Qian,et al.  Anti-radiation damage effect of polyethylenimine as a toll-like receptor 5 targeted agonist , 2012, Journal of radiation research.

[38]  Shuangge Ma,et al.  A prospective, multicenter study of complementary/alternative medicine (CAM) utilization during definitive radiation for breast cancer. , 2013, International journal of radiation oncology, biology, physics.

[39]  R. Baskar,et al.  Cancer and Radiation Therapy: Current Advances and Future Directions , 2012, International journal of medical sciences.

[40]  F. Alves,et al.  Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer. , 2011, Brazilian oral research.

[41]  U. Hoeller.  5 – Radiotherapy-induced adverse events , 2011 .

[42]  K. Shimizu,et al.  Effect of Acupuncture on Salivary Immunoglobulin a after a Bout of Intense Exercise , 2010, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[43]  I. Higginson,et al.  Clinical Effectiveness and Safety of Acupuncture in the Treatment of Irradiation-Induced Xerostomia in Patients with Head and Neck Cancer: A Systematic Review , 2010, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[44]  G. Sanguineti,et al.  Sucralfate versus Mesalazine versus Hydrocortisone in the Prevention of Acute Radiation Proctitis during Conformal Radiotherapy for Prostate Carcinoma , 2003, Strahlentherapie und Onkologie.

[45]  R. Riffenburgh,et al.  Acupuncture for xerostomia , 2002, Cancer.

[46]  H. Athanassiou,et al.  Randomized phase III trial of radiation treatment +/- amifostine in patients with advanced-stage lung cancer. , 2001, International journal of radiation oncology, biology, physics.

[47]  P. Johnstone,et al.  Acupuncture for pilocarpine-resistant xerostomia following radiotherapy for head and neck malignancies. , 2001, International journal of radiation oncology, biology, physics.