Persistent radiation-induced alopecia in patients with central nervous system tumors and head and neck sarcomas.

Abstract

e23072 Background: Persistent radiation-induced alopecia (pRIA), or incomplete hair regrowth 6 months following radiotherapy (RT) completion, poses a significant quality of life burden, but its clinical characteristics and management outcomes are not well understood. Methods: Retrospective database query of patients with primary central nervous system tumors or head and neck sarcomas evaluated at an oncodermatology clinic and diagnosed with pRIA between 1/1/11 and 9/19/18. Clinical data and standardized clinical photographs were analyzed. Alopecia was graded according to the CTCAE v5. Results: Sixty-two patients with pRIA were identified (mean [SD] age, 33 [19]; 75% female; 18 < 21 years at pRIA diagnosis). The most common diagnoses were medulloblastoma (20, 32%) and glioblastoma multiforme (17, 27%). Mean duration between RT and pRIA diagnosis was 3.1 years (95% CI, 2.3-4.2). Additional cancer therapies included surgery (57, 92%), cytotoxic chemotherapy (35, 57%), and combination cytotoxic + targeted therapy (24, 39%). Cancer type, age, number of chemotherapy agents, and duration between RT and pRIA diagnosis were significantly associated with alopecia type: mixed pattern (localized and diffuse) alopecia was predominant in younger patients with medulloblastoma exposed to greater number of agents (p < .005). Alopecia grade 2 ( > 50% hair loss) was predominant in patients that received concurrent chemotherapy and RT (p = .046). Among 22 patients treated with 5% minoxidil topical solution, a response was noted in 16 (73%) (Table). One patient receiving hair transplantation and one receiving scalp reconstruction had complete resolution of pRIA. Conclusions: Concurrent chemotherapy with RT may be a risk factor for grade 2 pRIA. Topical minoxidil may provide some benefit in pRIA; however, prospective trials are needed to assess efficacy. Procedural interventions should be considered as a viable therapeutic option in a subset of patients. [Table: see text]