Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer

Abstract

IMPORTANCE Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described.OBJECTIVE To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. MAIN OUTCOMES AND MEASURESThe clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. RESULTSOf the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, −0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (−0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction.CONCLUSIONS AND RELEVANCE Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.

Acne keloidalis nuchae: A role for low-dose radiotherapy

“…5 Both the cumulative dose and the fractional dose used are important in causing alopecia with radiotherapy. 9 Our experience indicates that the radiation dose needed to permanently kill hair and eliminate the disease in inflamed and friable AKN lesions is less than the dose required for noninflamed areas of the scalp.…”

Alopecia and neurocognitive dysfunction in Glioblastoma multiforme patients- Prevention feasibillity by dosimetric analysis in conformal radiotherapy techniques

“…Patchy alopecia is the most commonly observed pattern following radiation. 12 It leads to huge cosmetic disfigurement.…”

“…They have proven association with alopecia, neurocognitive dysfunction, and memory loss and that can have a profound impact on the patient's quality of life. [4][5][6] This raises the importance of taking into account these structures as additional OAR's in radiation planning along with other routine serial structures.…”

Management of complications from brain metastasis treatment: a narrative review

“…In patients experiencing chronic radiation alopecia, one study found that topical minoxidil 5% BID improved hair regrowth in 82% of patients and given its favorable safety profile, is a reasonable option for interested patients (35). Patients with significant chronic alopecia can also be referred for hair prosthesis.…”