1. PROPOLIS OBJECTIVE METHODOLOGY RESULTS CONCLUSIONS
Preliminary evidence of the effectiveness of a gel containing propolis in the prevention of the oral mucositis and the candidiasis in patients undergoing radiotherapy in the head and neck
Authors: Vladimir Reimar A. S. Noronha, Andrea Augusto Rodrigues*, Evandro Neves Abdo, Vagner Rodrigues Santos
INTRODUCTION
Cancers are genetic changes resulting from accumulated mutations in the genome. The origin of cancer is concomitant with the man origin and is also related to environmental factors and lifestyle habits. Patients with malignant tumors of the upper aerodigestive tract require multidisciplinary treatment, which aims to improve the quality of life throughout the cancer treatment, which includes surgery, radiotherapy and chemotherapy, associated or not. When the radiotherapy and the chemotherapy treatments are taken together, the possibility of side effects, that may be reversible or not, increases.
CANDIDIASIS
MUCOSITIS
It is the most common and disturbing side effect observed in the patients undergoing radiotherapy and/or chemotherapy.
It is an erythematous and ulcerative lesion of the mucosa and has inflammatory origin. It is aggravated in the presence of the Candida spp.
It is a fungal infection caused by Candida yeasts, probably due to the decrease in the salivary flow, common in the patients undergoing radiotherapy.
Both lesions present white patches on the tongue and oral mucosa and generally progress to the ulceration. The patients mainly report pain and / or burning sensation.
Clinical evaluation of tumor located on the tongue during the fourth week of radiotherapy: absence of candidiasis and presence of mucositis grade I. (A) evaluation of the tumor region, (B) evaluation of the left oral mucosa, (C) evaluation of the palate, (D) evaluation of the right oral mucosa. A B C D
PROPOLIS
It is a nontoxic natural substance collected by honeybees from various plant species.
It has a complex chemical composition.
It presents proven activity in in vitro studies: analgesic, antibacterial, anti-inflammatory, and antifungal.
Once it presents low side effects and is a mucoadherent  gel, it may be a good alternative for the prevention and treatment of the candidiasis and the superimposed mucositis, observed during and after the treatment with radiation in oncology.
Própolis Verde Bruta
Aspecto final do gel contendo própolis
Aspect of the gel mucoadherent
OBJECTIVE
METHODOLOGY
To show, preliminarily, the efficacy of a gel containing propolis in the prevention and treatment of the mucositis and the oral candidiasis in patients undergoing radiotherapy in the head and neck.
This research is a Phase II study, which lasted 12 weeks. It was done at the Faculty of Dentistry, in UFMG, between Sep/2010 and March/2011
Assessed for eligibility n=33
RESULTS
Excluded n=19 Not suitable for inclusion
The research began with 33 patients. From those, 14 completed the treatment using the gel containing propolis.
The antifungal resistance was most evident for the fluconazole and muconazole, both before and after the use of the gel.
The gel containing propolis was well accepted by the patients.
Included in the study n = 14
Patients harboring candidiasis after RT Treatment Group ( n=7)
Patients without candidiasis during the first   consultation before RT – Prevention Group ( n= 7)
Completed and Analyzed the study n = 14 (Completed the study and left after the 2nd exam)
The gel containing propolis was applied 24 hours before the beginning of the radiation and a dosage of 3.0 g was maintained every 8 hours (6a.m., 2p.m., 10p.m.).
The application of the gel was maintained for more two weeks after the last radiotherapy session. All patients were evaluated every seven days and the modifications were recorded.
Saliva was collected from patients before and after the initiation of the use of the gel containing propolis for the evaluation of the presence of Candida species and their susceptibility to the conventional antifungal agents through the Candifast ® kit.
CONCLUSIONS
The gel containing propolis hindered the development of the mucositis to no more than 2 degrees and no patient had their radiotherapy interrupted because of such side effect.
The gel was effective for the treatment and prevention of the mucositis and the candidiasis in patients that had undergone head and neck radiation.
However, further research should be conducted so that more data are obtained to confirm its effectiveness in relation to the protocol recommended by MASCC / ISOO Multinational Association for Support Care in Cancer
REFERENCES:
AHN, M.R; et al Suppression of tumor-induced angiogenesis by Brazilian propolis: major component artepilin C inhibits in vitro tube formation and endothelial cell proliferation. CancerLetters.; 252:
BANKOVA, V. Chemical diversity of propolis and the problem ofstandardization. Journal Ethnopharmacol.;100: , 2005a
PAROLIA, A.;et al. Propolis and its potential uses in oral health. International Journal of Medicine and Medical Sciences. 2:
SPETCH, L. Oral complications in the head and neck radiation patient. Introduction and scope of the problem. Supp Care Cancer; 10: 36-39, 2002