Results of scalp cooling during anthracycline containing chemotherapy depend on scalp skin temperature

A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and Its Prevention

“…Documentation of other variables, however, identified some of the factors other than high drug dose that affect the success of cooling, and these included comorbidity, current medications, age, menopause, hair thickness, and nicotine intake . Moreover, Komen et al (2016) showed that of 62 breast cancer patients (median age 60) treated with up to six cycles (median three cycles) of anthracycline (epirubicin or adriamycin) chemotherapy, 13 (12%) did not require a wig . Cigler et al (2015) evaluated the effects of scalp cooling on 20 patients receiving docetaxel and cyclophosphamide with a total of four cycles over 3‐week intervals.…”

“…The estimated incidence of CIA is >60% for alkylating agents, >80% for antimicrotubular agents, 60%-100% for topoisomerase inhibitors, and 10%-50% for antimetabolites [55]. Although even just a single drug treatment can significantly reduce hair density [56], polytherapies (consisting of two or more drugs) produce higher incidence and more severe CIA compared with single administrations [53]. In most cases, HF stem cells appear to be largely unaffected by chemotherapy agents because hair regenerates 3-6 months after treatment [51,57].…”

“…It has previously been reported that a subcutaneous temperature of 228C was a "threshold" temperature necessary for effective cooling, and a close relationship exists between epicutaneous and subcutaneous temperatures during cooling, with 228C subcutaneous corresponding to an epicutaneous temperature of 198C [97]. More recently, found that breast cancer patients whose scalp temperature was reduced to 188C were the least likely to require a wig following anthracycline treatment; the study also raised the important issue of device fitting, to ensure that all areas of the scalp are cooled effectively, so that adequately low temperatures are achieved [56].…”

Scalp hypothermia as a preventative measure for chemotherapy‐induced alopecia: a review of controlled clinical trials

“…studied the relationship between scalp temperature and CIA prevention using the Paxman scalp cooling cap in 62 breast cancer patients undergoing anthracycline chemotherapy. Greater hair preservation was observed at scalp temperatures of 18 °C as compared to 20 °C ( P < 0.01), suggesting that the efficacy of scalp cooling is reliant upon scalp temperature …”

“…Greater hair preservation was observed at scalp temperatures of 18°C as compared to 20°C (P < 0.01), suggesting that the efficacy of scalp cooling is reliant upon scalp temperature. 46 Subjective evaluations Many studies did not describe their scalp cooling protocols in detail; others provided no consistent definition of successful treatment or the time at which successful scalp cooling was measured. Furthermore, outcome evaluations largely varied, with different studies making use of both standardized (i.e.…”