Efficacy of acupuncture in managing radiotherapy/chemotherapy-induced oral mucositis: a systematic review and meta-analysis.

Purpose: To evaluate the preventive and therapeutic efficacy of acupuncture modalities in radiation/chemotherapy-induced oral mucositis (RIOM/CIOM) management through evidence synthesis.

Methods: A systematic search was performed in eight biomedical databases: four English-language databases (PubMed, Embase, Web of Science, and Cochrane Library) and four Chinese-language databases (China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and SinoMed) for studies published up to July 25, 2025. Randomized controlled trials (RCTs) in English or Chinese investigating acupuncture for RIOM/CIOM were included. Dual independent extraction with standardized forms and quality appraisal using the Cochrane RoB 2.0 tool were implemented. The primary outcome was OM grading according to WHO, RTOG, or other recognized scales. The evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results: Eleven RCTs (n = 865) were included. Acupuncture significantly reduced moderate-to-severe OM incidence [RR = 0.58, 95% CI:0.45-0.76; P < 0.0001), with therapeutic interventions showing greater efficacy than preventive approaches (P < 0.0001). Auricular acupuncture showed substantial benefit (RR = 0.54 vs manual technique RR = 0.97). Other outcomes revealed significant ulcer duration reduction (SMD = -1.13, 95% CI -1.71-[-0.55]; P = 0.0001), pain score improvement (SMD = -1.89, P = 0.0005), and enhanced immune modulation (TGF-β1/IL-6 levels) with Karnofsky performance increase (MD = 5.83, P = 0.004). No severe adverse events were reported. The quality of evidence was rated as moderate due to significant heterogeneity observed across the studies.

Conclusions: The systematic review and meta-analysis found that acupuncture was effectively associated with preventing and treating RIOM/CIOM, shortening ulcer duration, reducing ulcer size, alleviating pain, and improving quality of life, although the evidence level was moderate. The finding suggests that more high-quality RCTs were needed for validation.