Over the past decade, the positioning of acupuncture in the field of tumor therapy has undergone a remarkable transformation: it has evolved from an adjuvant therapy primarily for symptomatic control into a systematic intervention strategy that integrates both the exploration of antitumor mechanisms and clinical integrated antitumor practice. Bolstered by the continuous accumulation of high-level clinical evidence, international authoritative guidelines have officially incorporated acupuncture into the standard management pathways for cancer-related pain, hot flashes and a variety of treatment-associated adverse reactions, which marks the widespread recognition of its status in cancer supportive care. In terms of theoretical construction, the academic framework of acupuncture for antitumor therapy has become increasingly mature, with pivotal advances achieved in the clinical system that combines local interventions represented by peritumoral surrounding acupuncture with the holistic regulation of traditional meridian-acupoint acupuncture. At the mechanistic research level, acupuncture has been proven to possess the capacity for multi-dimensional regulation of the tumor microenvironment, including modulating angiogenesis, remodeling immune cell functions and regulating neuroendocrine networks, thus synergistically enhancing the antitumor effects of modern medical therapies. Looking ahead, the development of acupuncture oncology is in urgent need of focusing on the standardization of treatment pathways, the verification of short- and long-term efficacy as well as survival benefits through large-sample clinical studies, and the elucidation of multi-target synergistic mechanisms between acupuncture and modern antitumor therapies. These efforts will further propel its advancement toward a precise and systematic integrated medical model.