Propolis may reduce severity for radiotherapy-induced oral mucositis: a systematic review

Oral mucositis (OM) is one of the most common and debilitating complications in patients undergoing radiotherapy for head and neck tumors. Its consequences include intense pain, nutritional impairment, and compromised treatment adherence. Within this context, propolis has been investigated as a therapeutic alternative because of its anti-inflammatory, healing, and antimicrobial properties. The aim of this systematic review is to identify the propolis formulations in the prevention and treatment of OM in patients undergoing radiotherapy in the head and neck region. Searches were performed in PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar. The study design was clinical trials randomized or not, prevention and treatment for OMS were evaluated as well as adverse effects and outcomes. The risk of bias in the studies was assessed using the ROBINS-I tool. Four clinical trials were included, totaling 134 participants. Three studies used propolis as a mouthwash and one as a gel. Most studies used the NCI-CTCAE scale for assessing OM and one study applied the World Health Organization scale. Propolis may reduce the severity of oral mucositis compared to placebo. The best results in the current literature were obtained by the third week of treatment, especially with the mouthwash formulation. Propolis appears to be promising for the management of OM, showing relevant therapeutic benefits, especially because of its easy application, safety profile, and low cost. However, new clinical trials are needed to standardize formulations, dosages, and assessment scales so that propolis can be included in clinical cancer care guidelines.