Scalp hypothermia for the prevention of chemotherapy-induced alopecia in breast cancer

Abstract

Background. Breast cancer (BC) is a socially significant disease in women all over the world, ranking 1st in the structure and 5th in the number of deaths. Polychemotherapy in the complex treatment of BC accounts for approximately 80%. The main side effect that significantly affects the quality of life is alopecia, which occurs on average in 65% of patients.
 Aim. To evaluate the efficacy and tolerability of scalp hypothermia (SHT) for the prevention of chemotherapy-induced alopecia in patients with BC.
 Materials and methods. From June 2016 to September 2023, 75 patients with a median age of 44.1 years with stage I–IV BC were observed. All patients received cytotoxic therapy at various stages of treatment. To prevent alopecia, local SHT was used using an Orbis II device (Paxman Coolers, United Kingdom).
 Results. Stage I of the disease was observed in 18 (24%) patients, stage II in 22 (29.3%), stage III in 30 (40%), and stage IV in 5 (6.7%). Patients received 5 different neo- and adjuvant regimens of polychemotherapy. Taxane-containing combined regimens prevailed. 364 SHT sessions (4–8 sessions per patient) were performed; 48 (64%) patients received the procedure in full. Complete hair preservation was achieved in 43 (57.3%) patients. Grade 1 alopecia was observed in 19 (25.4%) patients and grade 2 in 9 (12%) patients. Of the 5 patients with advanced BC, grade 2 alopecia was reported in 1 patient, grade 3 in 3, and grade 4 in 1. Side effects were reported in 16% of cases; the most common were a feeling of cold and a slight headache. Due to the intolerance of the cold helmet, 3 patients refused to use it. No scalp metastases were observed during the follow-up. During the procedure, almost all patients noted a high level of comfort.
 Conclusion. Local SHT is an effective method of preventing cytotoxic therapy-induced alopecia in patients with BC. It improves the psychological and social adaptation of patients.