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Scalp cooling does not pose a risk for scalp metastases

Scalp cooling is a “viable and effective method” for preventing hair loss during cancer treatments and does not appear to pose a risk for scalp metastases, concluded a US overview of 83 papers, presented at the 12th International Conference of Early Breast Cancer (St Gallen, Switzerland 16 to 19 March). An additional UK abstract concluded that the DigniCap™ system works in different ethnic hair types.

Hair loss is a distressing and common side effect of chemotherapy that can be reduced by scalp cooling . The concept behind scalp cooling is that it lowers the temperature of the scalp, thereby reducing blood flow and the metabolism of chemotherapy, so that hair is less likely to be damaged by treatment.

In the overview study Hope Hugo and colleagues, from the UCSF Comprehensive Cancer Center (San Francisco, California) , reviewed 83 papers published between 1972 and 2009 involving more than 4,000 patients. At least four cooling systems were included in the analysis including DigniCap, Penguin, Paxman and Gel Caps.

The investigators found that seven randomised trials (including 12 to 77 patients) reported good hair preservation in 10 to 100% of patients, with six out of seven studies demonstrating a significant improvement for patients randomised to treatments over those randomised to the control group. In 12 non randomised trials, 46 to 100% of patients were reported to have good to excellent hair preservation. The six studies, involving 1593 patients, who evaluated the incidence risk of scalp metastases, showed that 10 patients (0.6%) developed scalp metastases. None, however, was found to be an isolated site of first metastasis. Common side effects of scalp cooling treatments reported in the studies included headache, feeling cold and ear pain. The success of scalp cooling in hair preservation, the US investigators found, was dependant on the type of cooling system and chemotherapy regimen used. Worse outcomes were obtained for the combination of anthracyclines and taxanes.

In the second abstract Kevin Saltmarsh, a chemotherapy nurse from King’s College, (London, UK) looked at the effectiveness of scalp cooling in patients from different ethnic backgrounds. To date most studies have been undertaken in Caucasian and Asian patients. The study in 15 consecutive patients, describing their ethnic background as African black, British black, Brazilian white, Caribbean, British white and French white, did not demonstrate any differences in efficacy.

“What seems more significant to outcome is whether woman have coloured their hair, used heat treatments like straighteners or hair rollers, plaited their hair or worn wigs,” said Saltmarsh, adding that such women benefit from lower temperature settings. “In recent years there’s been a move to introduce higher temperature settings, such as 5 or 6 degrees centigrade, since we found that women really suffered with temperatures of minus 10 or 11 degrees centigrade,” he added.

The DigniCap™ system, which they used in the study, allows scalp temperature to be regulated and visualised on a screen.

H Rugo and M Melisko. Efficacy and safety of scalp cooling to prevent chemotherapy (CTX) induced alopecia: A review of available data. Abstract P331.
K Saltmarsh. Efficacy of scalp cooling not dependent on hair type. Abstract P329.

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