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

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.

[Prevalence and subtypes of systemic hypertension in an unselected patient population with severe obesity undergoing bariatric surgery]. / Prevalenza e tipologie di ipertensione arteriosa in una popolazione di pazienti non selezionati affetti da obesità morbigena in previsione di intervento di chirurgia bariatrica.

BACKGROUND: Obesity plays a pivotal role in the development of systemic hypertension and the two diseases are often related. Severe obesity is getting more and more prevalent in our country. The aim of this study was to evaluate the prevalence of systemic hypertension in an unselected population of obese patients observed in the Regional Referral Center for Surgical Obesity of our hospital. METHODS: 233 consecutive patients (52 male, 181 female, mean age 42 years, mean weight 120 kg, mean body mass index [BMI] 43.7 kg/m2) were screened in order to plan a surgical procedure for severe obesity. Each patient underwent cardiovascular clinical evaluation, ECG and echocardiographic examination, blood pressure ambulatory monitoring, and 24h Holter monitoring. RESULTS: Thirty-five percent of patients were under drug treatment for hypertension or were at least aware of being hypertensive; among the remaining 65% of patients who declared having normal blood pressure, 33% suffered from systemic hypertension, 11% had isolated clinical hypertension, and 14% had masked hypertension. Thus, the global prevalence of systemic hypertension in this population raised to 72.5%. ECG and echocardiographic findings were normal in about 90% of the whole population, whereas 24h Holter monitoring showed minor or major abnormalities in approximately 25% of patients. At a follow-up of at least 18 months, a subgroup of 48 patients showed a decrease in body weight from 129 to 92 kg, BMI from 47 to 33 kg/m 2, blood pressure from 134.4/86.4 to 127.7/81.1 mmHg, and heart rate from 79.7 to 69.4 bpm. CONCLUSIONS: The prevalence of systemic hypertension in an unselected population of severely obese patients is much higher than in the general population. The surgical procedures performed in the Regional Referral Center for Surgical Obesity of our hospital were virtually free from serious adverse events and proved to be effective in reducing not only body weight and BMI but also blood pressure. We believe that ambulatory blood pressure and 24h Holter monitoring are the most relevant examinations to be performed in these patients in the preoperative period.