Radiation- and Chemotherapy-Induced Permanent Alopecia: Case Series

Haider, Mansoor A.; Hamadah, Issam; Almutawa, Abdulmonem

doi:10.2310/7750.2012.12033

Cited by 19 publications

(32 citation statements)

References 18 publications

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“…Hair loss, either temporary or permanent, is one of the most stressful side effects for patients undergoing oncologic treatment (1)(2)(3)(4)(5). Radiation-induced alopecia may permanently alter the self-perception of the neurooncological patients and have a significant impact on their quality of life (2,5).…”

Section: Discussionmentioning

confidence: 99%

“…On review of the available literature regarding photon-based radiotherapy, the doses that have been reported to cause hairloss varied widely. Doses as low as 2 and 3 Gy in a single fraction might cause temporary alopecia according to some authors (4,10,21,22). In a study regarding the use of VMAT for whole-brain irradiation (WBRT) in patients with multiple brain metastases (19), the authors hypothesized that the threshold dose for temporary alopecia is around 10 Gy in 5 fractions.…”

Section: Dose-response Relationship For Acute Alopeciamentioning

confidence: 99%

“…Due to the high radiosensitivity of hair follicles, radiotherapy (RT) may induce hair-loss with a huge psychological impact and, thus, negative effects on patient's quality of life, also in case of limited life expectancy (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

et al. 2020

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Purpose: To determine dose constraints that correlate with alopecia in patients treated with photon-based Volumetric Modulated Arc Therapy (VMAT) for primary brain tumors.Methods: During the treatment planning process, the scalp was drawn as a region of interest. Dose received by 0.1 cc (D 0.1cc ), mean dose (D mean ), absolute volumes receiving different doses (V 16Gy , V 20Gy , V 25Gy , V 30Gy , V 35Gy , V 40Gy , and V 43Gy ) were registered for the scalp. Alopecia was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Receiver operating characteristics (ROC) curve analysis was used to identify parameters associated with hair-loss.Results: One-hundred and one patients were included in this observational study. At the end of radiotherapy (RT), 5 patients did not develop alopecia (D mean scalp 3.1 Gy). The scalp of the patients with G1 (n = 11) and G2 (n = 85) alopecia received D mean of 10.6 Gy and 11.8 Gy, respectively. At ROC analysis, V 16Gy20Gy ≥ 5.2 cc were the strongest predictors of acute alopecia risk. Chronic hair-loss assessment was available for 74 patients: median time to recovery from G2 alopecia was 5, 9 months. The actuarial rate of hair regrowth was 98.1% at 18 months after the end of RT. At ROC analysis, V 40Gy43Gy ≥2.2 cc were the strongest predictors of chronic G2-alopecia risk. V 20Gy, V 40Gy , and D 0,1cc were shown to be independent variables according to correlation coefficient r.Conclusions: V 20Gy and V 40Gy were the strongest predictors for acute and chronic G2 hair-loss, respectively. The low-dose bath typical of VMAT corresponds to large areas of acute but transient alopecia. However, the steep dose gradient of VMAT allows to reduce the areas of the scalp that receive higher doses, minimizing the risk of permanent alopecia. Scoccianti et al. Predictors of Radiotherapy-Induced AlopeciaThe application of our dosimetric findings for the scalp may help in reducing the alopecia risk and also in estimating the probability of hair-loss during patient counseling before starting radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Dose-response Relationship For Acute Alopeciamentioning

confidence: 99%

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Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

et al. 2020

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“…7 KİA'da skatrisyel alopesi gelişimi nadiren bildirilmiştir. 19 Özellikle busulfan ve yüksek doz siklofosfamid alan hastalarda ve kemik iliği transplantasyonunda rapor edilmiştir. 5,6 Çalışmamızda, skatrisyel alopesi gelişimine ait bir bulgu yoktu.…”

Section: Discussionunclassified

Evaluation of Videodermoscopic Features of Chemotherapy Induced Alopecias

Köse¹,

Akosman²,

Borlu³

2020

Turkiye Klinikleri J Dermatol

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ÖZET Amaç: Kemoterapiyle indüklenen alopesi, onkoloji hastalarında psikososyal açıdan kanser tedavisinin en yıkıcı bulgularından bir tanesidir. Bu çalışmada, kemoterapiyle indüklenen alopesilerin değerlendirilmesinde videodermoskopik incelemenin yerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, kemoterapi alan ve klinik inceleme sonrası kemoterapiyle indüklenen alopesi tanısı konan ardışık 41 hasta dâhil edildi. Hastaların yaş, cinsiyet, deri fototipi, malignite tanısı, tedavi protokolündeki kemoterapi ajanları ve alopesinin yaygınlığı kaydedildi. Trikoskopik fotoğraflar X30-X50'lik büyütmeler ile elde edildi. Literatürdeki yayınlar ile oluşturulan kontrol listesine göre trikoskopik bulgular incelendi. Bulgular: Foliküler bulgulardan olan saç çapı değişkenliği hastaların tümünde saptandı. Siyah nokta %78, sarı nokta %75,6, kırık saç %51,2, Pohl-Pinkus %46,3, ünlem işareti saçlar ve alev figürleri %26,8 oranında izlendi. İki renkli, kısa vellus ve moniletrix-benzeri saçlar %22, domuz kuyruğu ve incelen saç %19,5, lale saç %14,6 ve zig zag saç ise %9,8 oranında görüldü. Daha nadir izlenen diğer bulgular V saç %7,3, virgül saç, peripilar bulgu ve boş folikül ise %4,9 oranında idi. Nötrofil benzeri saç (%7,3) ilk kez tanımlandı. Sonuç: Kemoterapi ile indüklenen alopesilerde zig zag saç, lale saç ve V saç yeni trikoskopik bulgulardı. Nötrofil benzeri saçlar ise ilk kez bu çalışmada tanımlandı. Kemoterapiyle indüklenen alopesilerin dermoskopisi, alopesi areata ve trikotillomani ile bazı benzer bulgular göstermektedir.Anah tar Ke li me ler: Alopesi; dermoskopi; kemoterapi; kemoterapi ile indüklenen alopesi; trikoskopi; videodermoskopi ABS TRACT Objective: Chemotherapy induced alopecia is one of the most devastating findings of cancer treatment for oncology patients psychologically. In this study, we aimed to investigate the significance of videodermoscopic features of chemotherapy induced alopecia. Material and Methods: Fourty-one patients, who were treated with chemotherapy and were diagnosed as chemotherapy induced alopecia after clinical evaluation, were included. The age, gender, skin phototype, diagnosis of malignancy, chemotherapy agents in the treatment protocol, location of the alopecia and the severity of alopecia were recorded. Trichoscopic photos were held in X30-X50 fold magnifications. All of the trichoscopic findings were examined in accordance with the checklist which was described by the features of the previous publications. Results: Hair diameter diversity were detected in all of the patients as a follicular feature. Black dots were established in 78%, yellow dots in 75.6%, broken hairs in 51.2%, Pohl-Pinkus in 46.3%, exclamation mark hairs and flame figures in 26.8% of the patients. Bicoulored, short vellus and moniletrix-like hairs were detected in 22%, pigtail and tapering hairs in 19.5%, tulip hairs in 14.6% and zigzag hairs in 9.8% of the patients. V hairs in 7.3%, comma hairs, peripilar finding and empty follicles were established in 4.9% of the patients as other rare findings. N...

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“…Tolerance dose to scalp has been reported for permanent alopecia after definitive radiation therapy for brain tumors [ 12 , 29 ]. Hair loss, at least temporarily, occurs in most patients receiving WBRT with conventional fractionation [ 11 ].…”

Section: Discusssionmentioning

confidence: 99%

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

et al. 2015

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BackgroundWhole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia.MethodsSuitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means.ResultsAll six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V24 (9 cc vs. 44 cc, p < 0.0000) and V30 (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area.ConclusionsHS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia.

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Radiation- and Chemotherapy-Induced Permanent Alopecia: Case Series

Abstract: A comprehensive multicenter and multidisciplinary study is required to determine the definite causative agents, doses, and other cofactors that induce permanent alopecia following chemotherapy/radiotherapy, as well as the means to avoid this distressing outcome in surviving patients.

Cited by 19 publications

References 18 publications

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

Evaluation of Videodermoscopic Features of Chemotherapy Induced Alopecias

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

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