Prevention of chemotherapy-induced alopecia using an effective scalp cooling system

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Abstract

Alopecia is a distressing side-effect of cancer treatment. Taxanes (TX), anthracyclines (ANR) and etoposide (ET) have been consistently associated with significant alopecia. We studied an effective scalp cooling system, the Penguin Cold Cap system™, for the prevention of chemotherapy-induced alopecia in 70 patients receiving chemotherapy, including one of the following major alopecia-causing agents: Group A, TX-based regimes (without ANR); Group B, TX+ANR; Group C, ANR-based regimes (without TX); Group D, ET-based regimes. Protection from hair loss was achieved by maintaining scalp temperatures below 15°C before, during and after chemotherapy by frequent changing of the caps. Assessment was carried out using a grading system from 0 to 4. Grades 0–2 were considered as satisfactory hair protection, whilst Grades 3–4 were considered failures. 57 patients were evaluable for assessment. An overall 81% protection was achieved. In groups C and D 11 of 12 patients (92%) had no alopecia, whilst 30 of 34 patients (88%) treated with taxanes had adequate hair protection. In Group B, 4 of 11 patients (36%) had adequate hair protection. The system was well tolerated and is a very effective method for protection from hair loss caused by TX, ANR and ET. Our results are comparable with and, in most cases, better than those reported in other studies using various alopecia preventive methods.

Introduction

Alopecia is one of the most unwelcome side-effects of chemotherapy. Although not life-threatening, it can be psychologically devastating and can even lead some patients to reject potentially curative treatment.

The degree of alopecia varies amongst different drugs. Chemotherapeutic agents such as the taxanes (TX), anthracyclines (ANR) and etoposide (ET) have been shown to have significant antitumour activity in solid tumours either alone or in combination regimes 1, 2, 3, 4, 5, 6. These drugs are also associated with significant alopecia as one of their main side-effects. The percentage of patients experiencing alopecia associated with the use of anthracyclines or taxanes is over 70% in most studies, whilst similar results have been reported for etoposide 7, 8, 9, 10, 11. Alopecia induced by these agents is dose dependent, whilst its severity also depends on the combination of other cytotoxic agents 3, 12.

A variety of different methods have been used for the prevention of chemotherapy-induced alopecia. These include scalp tourniquets, scalp cooling systems and immunomodulator techniques 13, 14, 15, 16.

The cooling systems are based on the theory that by cooling the scalp, vasoconstriction is produced, which reduces the amount of drug delivered to the hair follicles. Cellular uptake by the hair follicle, which occurs more readily at warmer temperatures, is also reduced [17]. Several techniques have been used: bags with crushed ice, packs or caps containing cryogel and caps connected to a cooling device. Hair preservation is achieved in many cases, although studies showing failure of hair loss prevention have also been reported 18, 19, 20. Recent studies have shown that the efficacy of a scalp cooling system is inversely associated with epi- and subcutaneous scalp temperatures 17, 21. Based on these findings, pre- and postchemotherapy scalp-cooling has been utilised in order to maintain steady, low scalp temperatures. Encouraging results have been reported in small studies, using anthracycline-containing regimes 17, 18, 22.

The Penguin Cold Cap system™ is a scalp cooling system, which is based on previous research findings. The aim of this study was to evaluate the applicability and efficacy of this new cooling system in patients receiving various chemotherapeutic regimes that are frequently associated with significant alopecia.

Section snippets

Patients and methods

The Penguin Cold Cap system™ was studied in patients who received chemotherapy regimes containing at least one drug from three main alopecia-causing drug groups: taxanes (TX), anthracyclines (ANR) or etoposide (ET). No previous chemotherapy or brain radiotherapy was allowed. The method was approved by our Ethics Committee. The system was provided by MSC Hellas A.E.

The above cold cap system offers protection from hair loss by maintaining scalp temperatures below 15°C before, during and after

Results

70 patients entered the study. Table 1 summarises patients' characteristics. The main tumour types treated were: lung cancer (20 pts, 30%), cancer of an unknown primary (11 pts, 16%) and breast cancer (9 pts, 13%). There was an even distribution of male and female patients with a mean age of 57 years (range: 25–75). The patients were divided into four groups according to the main alopecia-causing drug: Group A, TX-based regimes (without ANR); Group B, TX+ANR; Group C, ANR-based regimes (without

Discussion

Alopecia is a distressing side-effect of chemotherapy, having a negative impact on the quality of life of most patients [24]. Several methods of preventing chemotherapy-induced alopecia have been used over the years. The most widely applied method is the cooling of the scalp by a variety of techniques ranging from ice packs applied to the entire scalp to more sophisticated methods which use cryogel caps with or without tourniquets or cold air 13, 20, 23, 25. These methods are based on the

Acknowledgements

The authors wish to express their gratitude to Medical Specialties of California UK for providing the Penguin Cold Caps used in this study and MSC Hellas A.E. who sponsored this study and the cold therapy nurses Maria Kravariti and Photini Masoura for their significant contribution to the success of cold therapy.

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