Hair Preservation Research Articles

Scalp Cooling: A Literature Review of Efficacy, Safety, and Tolerability for Chemotherapy-Induced Alopecia .

More than 75% of patients with cancer cite alopecia as the most feared side effect of treatment, with as many as 10% considering treatment refusal. Despite wide acceptance in other countries, scalp cooling to reduce chemotherapy-induced alopecia (CIA) has been uncommon in the United States because of longstanding concerns of scalp metastases and a lack of reliable efficacy data. . This article reviews 40 years of efficacy, safety, and tolerability literature on scalp cooling to prevent CIA. . A systematic review was performed in PubMed and CINAHL®. Forty articles were reviewed, with 12 articles demonstrating high levels of evidence and meeting inclusion criteria. Comparative trials, systematic reviews, and one large single-arm trial were included. . Scalp cooling efficacy is dependent on many factors but demonstrates better hair preservation than no cooling. No increase in scalp metastases or statistically significant difference in overall survival was seen in retrospective safety data when cooling was used. Few patients discontinue cooling early because of adverse experiences.

Abstract S5-02: Scalp cooling alopecia prevention trial (SCALP) for patients with early stage breast cancer

Abstract Background Adjuvant chemotherapy decreases the risk of breast cancer recurrence. However, it is associated with distressing side effects, including alopecia. Women consider chemotherapy-induced alopecia as one of the most severe side effects. In many countries, scalp cooling is used to prevent chemotherapy-induced alopecia. It causes cutaneous vasoconstriction, which reduces blood flow to hair follicles during peak plasma concentrations of the drug and may reduce cellular uptake of these agents. It also results in reduced biochemical activity, which makes hair follicles less susceptible to the damage of chemotherapy. There are no randomized trials assessing this approach with modern scalp cooling and success rates in non-randomized trials have varied. Methods We conducted a multi-center randomized non-blinded controlled prospective trial to evaluate the safety and efficacy of the Orbis Paxman Hair Loss Prevention System (OPHLPS) in reducing chemotherapy-induced alopecia. Women with stage I-II breast cancer planned to receive neoadjuvant or adjuvant anthracycline- or taxane- based chemotherapy for at least four cycles were eligible. Participants were randomized in a 2:1 ratio to scalp-cooling or no cooling. Scalp-cooling was done using the OPHLPS 30 minutes prior to, during and 90 minutes after each chemotherapy. The primary efficacy endpoints were hair preservation, defined as CTCAE 4 alopecia <2 (assessed by an independent and blinded evaluator), and device safety. We planned to enroll 235 patients to provide 85% power to detect a 20% difference in hair preservation (i.e. 15% with no cooling and 35% with scalp-cooling). Secondary endpoints included wig/scarf use and quality of life assessed by the EORTC QLQ-30, HADS and BIS. Participants will be followed for 5 years post-study for time to first recurrence, overall survival, site of first recurrence, and incidence of isolated scalp metastasis. One interim analysis was planned to allow the study to stop early for efficacy (superiority) after 95 and 47 patients were enrolled to cooling or no cooling, respectively, and have been evaluated for the primary endpoint. To maintain the overall type 1 error rate, an O'Brien-Fleming spending function has been used to set the superiority boundaries (interim boundary was calculated as p=0.0061 (or Z=2.509)). Results This is the first prospective randomized trial with modern scalp cooling in the world. At the time of the interim analysis, 95 patients in the cooling group and 47 patients in the no cooling group were evaluable and had completed 4 cycles of chemotherapy. Among them, 48 (50.5%) out of 95 in the cooling group and 0 (0%) out of 47 in the no cooling group had hair preservation. The one-tailed p-value from the Fisher's exact test is <0.0001, which crosses the superiority boundary (p=0.0061). Thus, on 9/26/2016, the DSMB decided to stop the study early and release the results. Our trial shows that scalp cooling using OPHLP is highly effective in hair preservation and should become available for patients who receive chemotherapy for early breast cancer. These data and secondary endpoint analysis data will be presented. We are seeking FDA approval for the OPHLPS. Citation Format: Nangia JR, Wang T, Niravath PA, Otte K, Osborne CR, Papish S, Holmes FA, Abraham J, Goldfarb S, Courtright JG, Paxman RJ, Rude MB, Hilsenbeck SG, Osborne CK, Rimawi MF. Scalp cooling alopecia prevention trial (SCALP) for patients with early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S5-02.

Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer

Chemotherapy may induce alopecia. Although scalp cooling devices have been used to prevent this alopecia, efficacy has not been assessed in a randomized clinical trial. To assess whether a scalp cooling device is effective at reducing chemotherapy-induced alopecia and to assess adverse treatment effects. Multicenter randomized clinical trial of women with breast cancer undergoing chemotherapy. Patients were enrolled from December 9, 2013, to September 30, 2016. One interim analysis was planned to allow the study to stop early for efficacy. Data reported are from the interim analysis. This study was conducted at 7 sites in the United States, and 182 women with breast cancer requiring chemotherapy were enrolled and randomized. Participants were randomized to scalp cooling (n = 119) or control (n = 63). Scalp cooling was done using a scalp cooling device. The primary efficacy end points were successful hair preservation assessed using the Common Terminology Criteria for Adverse Events version 4.0 scale (grade 0 [no hair loss] or grade 1 [<50% hair loss not requiring a wig] were considered to have hair preservation) at the end of 4 cycles of chemotherapy by a clinician unaware of treatment assignment, and device safety. Secondary end points included wig use and scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Hospital Anxiety and Depression Scale, and a summary scale of the Body Image Scale. At the time of the interim analysis, 142 participants were evaluable. The mean (SD) age of the patients was 52.6 (10.1) years; 36% (n = 51) received anthracycline-based chemotherapy and 64% (n = 91) received taxane-based chemotherapy. Successful hair preservation was found in 48 of 95 women with cooling (50.5%; 95% CI, 40.7%-60.4%) compared with 0 of 47 women in the control group (0%; 95% CI, 0%-7.6%) (success rate difference, 50.5%; 95% CI, 40.5%-60.6%). Because the 1-tailed P value from the Fisher exact test was <.001, which crossed the superiority boundary (P = .0061), the data and safety monitoring board recommended study termination on September 26, 2016. There were no statistically significant differences in changes in any of the scales of quality of life from baseline to chemotherapy cycle 4 among the scalp cooling and control groups. Only adverse events related to device use were collected; 54 adverse events were reported in the cooling group, all grades 1 and 2. There were no serious adverse device events. Among women with stage I to II breast cancer receiving chemotherapy with a taxane, anthracycline, or both, those who underwent scalp cooling were significantly more likely to have less than 50% hair loss after the fourth chemotherapy cycle compared with those who received no scalp cooling. Further research is needed to assess longer-term efficacy and adverse effects. clinicaltrials.gov Identifier: NCT01986140.

EXPERIENCE OF SCALP COOLING FOR PREVENTION CHEMOTHERAPY-INDUCED HAIR LOSS

Short-term results of using Orbis II Paxman device for prevention of chemotherapy-induced alopecia were analyzed. A total of 98 sessions of scalp cooling were performed in 32 patients. Twenty-four (80 %) scalpcooled patients had good hair preservation. The level of comfort during the procedure was 87 %. Patients with breast cancer underwent 55 scalp cooling sessions. Good hair preservation was observed in 88% of cases. Grade 1 and 2 alopecia was observed in 12% of patients. Thus, the data obtained confirm that the use of scalp cooling methods can improve the quality of life for patients receiving chemotherapy.

1492P - Prevention of chemotherapy-induced alopecia in patients with breast or female genital tract cancer using sensor-controlled scalp-cooling

Chemotherapy (Ctx)-induced alopecia (CIA), produces a deep psychological impact in many women involved. Although sensor-controlled scalp cooling (SCSC) is effective in preventing CIA, it is infrequently used in many countries due to physicianś concerns regarding both safety and feasibility. This retrospective analysis was initiated to obtain detailed information about the effectiveness and safety of SCSC using the Paxman system (Paxman, Huddersfield, UK) in female patients (pts) exposed to CIA-inducing Ctx for breast cancer (BC) or genital tract malignancies in the clinical routine. 87 pts who underwent SCSC alongside Ctx from 2014-2016 were identified from our database: BC, 68; epithelial ovarian carcinoma, 14; others, 5; premenopausal, 42; postmenopausal, 45. 63 pts were treated in a curative intent, 24 were treated in a palliative setting; 57 pts were Ctx-naïve, 30 pts had a history of prior Ctx. The following Ctx regimens were used: anthracycline-based (A), 4; taxane-based (T), 21; AT-based, 48; others, 14. Pts were subjected to SCSC during each Ctx cycle. CIA was quantified according to the Dean score (DS) determined 3 wks after the last Ctx cycle. Data were analyzed regarding feasibility indicated by the SCSC completion rate, quality of hair preservation (success: DS 0-2, failure: DS 3-4), reasons of SCSC discontinuation, and safety. 57 pts (64.5%) completed SCSC, with 47 (53.0%) experiencing complete hair preservation (DS 0), and 10 (11.5%) showing partial success (DS 1-2). 30 pts (35.5%) discontinued SCSC, with CIA being the main reason in 21 pts (24.1%). Headache was reported in 4 (5.0%), and local discomfort ("feeling cold") in 3 pts (3.4%). In 2 pts (2.3%), the reason of discontinuation remained unclear. Side effects were all not severe and resolved completely after cessation of SCSC. In the clinical routine, SCSC using the Paxman system is feasible, safe and effective in order to prevent CIA in pts with BC and female genital tract carcinomas. The treatment success rate in our study is in good agreement with previous reports on SCSC although more pts in the palliative setting or with a history of prior Ctx have been included.

Sensor-controlled scalp cooling to prevent chemotherapy-induced alopecia in women treated for either breast or female genital tract cancer: A German experience using the Paxman system.

10118 Background: Chemotherapy (Ctx)-induced alopecia (CIA), produces a deep emotional impact in many female cancer patients (pts). Sensor-controlled scalp cooling (SCSC) has been found to be effective in preventing CIA, However, this technique is infrequently used in many countries due to concerns regarding both safety and feasibility. This prospective non-interventional study was initiated to gain detailed information about the effectiveness and reasons of discontinuation of SCSC using the Paxman system (Paxman, Huddersfield, UK) in German women exposed to CIA-inducing Ctx due to breast cancer (BC) or genital tract malignancies. Methods: 72 pts were included: BC, 54; epithelial ovarian carcinoma, 14; others, 4; premenopausal, 38; postmenopausal, 34. 51 pts were treated in a curative intent, 21 were treated in a palliative setting; 49 pts were Ctx-naïve, 23 pts had a history of prior Ctx. The following Ctx regimens were used: anthracycline-based (A), n = 4; taxane-based (T), n = 18; AT-based, n = 39; non-AT-based, n = 11. Pts were subjected to SCSC during each Ctx cycle. CIA was quantified according to the Dean score (DS) determined 3 wks after the end of Ctx. The primary endpoint was feasibility indicated by the treatment completion rate. Secondary endpoints were the degree of hair preservation (success: DS 0-2, failure: DS 3-4, or discontinuation of SCSC), and safety. Results: 46 pts (63.9%) completed SCSC, with 38 (52.8%) experiencing complete hair preservation (DS 0), and 8 (11.1%) showing partial success (DS 1-2). 26 pts (36.1%) discontinued CTCS, with CIA being the main reason in 18 pts (25%). Headache was reported in 4 (5.6%), and discomfort in 2 pts (2.8%). In the remaining 2 pts (2.8%), the reason for discontinuation was unclear. Side effects were not severe and resolved completely after cessation of SCSC. Conclusions: CTCS using the Paxman system is feasible, safe and effective in order to prevent CIA in pts with BC and female genital tract carcinomas in the clinical routine. Our study is in good agreement with previous reports on CTCS although including a higher proportion of pts in the palliative setting or with a history of prior Ctx.

Abstract OT3-02-08: Scalp cooling alopecia prevention trial (SCALP) for patients with early stage breast cancer

Abstract Background Adjuvant chemotherapy treats micro-metastatic disease and decreases the risk of breast cancer recurrence. However, it may be associated with distressing side effects, including alopecia. Women with breast cancer rate chemotherapy-induced alopecia as one of the most severe, troublesome, and distressing side effects of chemotherapy. In many countries, scalp cooling has been introduced to prevent or reduce chemotherapy-induced alopecia. The theory is that scalp cooling causes cutaneous vasoconstriction, which reduces blood flow to the hair follicles during peak plasma concentrations of the chemotherapeutic agents and therefore reduces cellular uptake of these agents. It also results in reduced biochemical activity, which makes hair follicles less susceptible to the damage of the chemotherapy agents. Historically success rates are have been variable, but based on non-randomized studies, scalp cooling appears to be effective in preventing chemotherapy-induced alopecia especially in more recent studies. Methods We are conducting a prospective multi-center randomized controlled non-blinded trial to evaluate the safety and efficacy of the Orbis Paxman Hair Loss Prevention System in reducing the incidence of chemotherapy-induced alopecia. Women with stage I-II breast cancer who will receive neoadjuvant or adjuvant anthracycline- or taxane-based chemotherapy, for at least four cycles are eligible. Participants are randomized in a 2:1 ratio to scalp-cooling or no cooling. Scalp-cooling is done using the Orbis Paxman Hair Loss Prevention System prior to, during and after each chemotherapy administration. The primary efficacy endpoints are hair preservation, defined as CTCAE v4 alopecia &amp;lt;2, and device safety. Two hundred and thirty five (235) patients are planned to be enrolled which will provide 85% power to detect a 20% difference in hair preservation, 15% in control group and 35% in scalp-cooling group . Secondary endpoints include: wig/scarf use and quality of life assessed by the EORTC QLQ-30, HADS and BIS. Study participants will be followed for 5 years post-study for time to first recurrence, overall survival, site of first recurrence, and incidence of isolated scalp metastasis. Citation Format: Nangia JR, Wang T, Rude M, Osborne C, Papish S, Abraham J, Holmes F, Savin M, Paxman R, Hilsenbeck SG, Osborne CK, Rimawi M. Scalp cooling alopecia prevention trial (SCALP) for patients with early stage breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-08.

EFFICACY OF SCALP COOLING ON THE PREVENTION OF ALOPECIA IN CANCER PATIENTS UNDERGOING ADJUVANT CHEMOTHERAPY

Background: Alopecia is a distressing side effect for patients undergoing chemotherapy and occasionally can lead to refusal of treatment. Scalp cooling is a method of preventing chemotherapy-induced alopecia.The aim of study: to determine the efficacy of scalp cooling on the prevention of alopecia in cancer patients undergoing adjuvant chemotherapy. Materials and methods: The study design used was a quasi experimentalresearch design. A purposive sample of 60 adult female patients, age ranged 18-60 years old, with cancer and scheduled to be treated with adjuvant chemotherapy for the first time after curative surgery who met the inclusion criteria it will be divided randomly 30 subjects in study group and 30 subjects in control group, the study group were received scalp cooling while they receiving their chemotherapy cycle while the control group received the routine hospital care. Tool used divided into two parts including structure interview questionnaire and physiologic measurement tool of hair loss.The results of this study: Revealed that there is good hair preservation by 86.6% in the study group(scalp cooling group (SCG)) compared to 16.7% in the control group where P=.000. Conclusion: The scalp cooling is effective in the prevention of chemotherapy induced alopecia in cancer patient. Recommendation: the scalp cooling is effective and should be applied for cancer patient during chemotherapy cycles thus the scalp cooling system should be available in the governmental hospitals and the women with cancer who take adjuvant chemotherapy should be encouraged to use scalp cooling to reduce total alopecia. Further psychological, clinical, and biological research is needed to improve the effect, tolerance, time, and side effect of the cooling procedure.

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

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.

M02* - Scalp cooling to prevent chemotherapy-induced hair loss

Background: Since about 1970 scalp cooling has been used to reduce chemotherapy-induced hair loss, a well documented common cause of distress to patients undergoing cancer treatment,with negative effects on body image and quality of life. We prospectively collected data to evaluate efficacy and safety of this technique, side effects and satisfaction of women receiving chemotherapy as a form trestment for breast cancer.Methods: The scalp cooling, by using a Paxman machine,it is composed of a refrigeranting unit whic is connected to a helmet of silicon. Inside flows a liquide which keeps the temperature at -4° C. Was offered to breast cancer patients starting chemotherapy containing anthracycline and/or taxanes;patients could be chemonaive or pretreated. Infusion times vary according to the schedule. Between june 2013 and december 2014 eightynine patients have been utilized pax in our hospital.Nurses completed questionnaires on patients,chemoterapy and scalp cooling characteristics during each session.Results were evaluated indicating the severity of hair loss according to CTCAE 3.0 during each chemoterapy session and taking into account patient's satisfaction during the last treatment.Results: All patients werw women (one man) with breast cancer who were mainly treated in the adjuvant setting (80%) and are chemonaive. The mean age was 53 years (range 35-72). The median number of cooling session was 5 (1-12). 70% of patientsreceived anthracycline-based polichemotherapy (ac or fec 75 every three weeks) and 30% received monotherapy with taxanes on weekly schedule. Alopecia G0 and G1 were registered at the end of chemoterapy in 62% of the patients,irrespective of the type of treatment . 100% of these patients reported to be satisfied in terms of hair preservation during their last session. 27% of patients discontinued scalp coolingtreatment because of severe alopecia (G2); all these patients were receiving anthracycline. Scalp cooling was stopped because of intolerance in 11% of patients mainly due to discomfort and longer time of infusion.Conclusion: The Paxman scalp cooler was found to be an effective technique with moderate side-effects for patients treated with commonly prescribed alopecia-inducing chemotherapy drugs.Lengthening infusion time seems to be the main limit of this system. Background: Since about 1970 scalp cooling has been used to reduce chemotherapy-induced hair loss, a well documented common cause of distress to patients undergoing cancer treatment,with negative effects on body image and quality of life. We prospectively collected data to evaluate efficacy and safety of this technique, side effects and satisfaction of women receiving chemotherapy as a form trestment for breast cancer. Methods: The scalp cooling, by using a Paxman machine,it is composed of a refrigeranting unit whic is connected to a helmet of silicon. Inside flows a liquide which keeps the temperature at -4° C. Was offered to breast cancer patients starting chemotherapy containing anthracycline and/or taxanes;patients could be chemonaive or pretreated. Infusion times vary according to the schedule. Between june 2013 and december 2014 eightynine patients have been utilized pax in our hospital.Nurses completed questionnaires on patients,chemoterapy and scalp cooling characteristics during each session.Results were evaluated indicating the severity of hair loss according to CTCAE 3.0 during each chemoterapy session and taking into account patient's satisfaction during the last treatment. Results: All patients werw women (one man) with breast cancer who were mainly treated in the adjuvant setting (80%) and are chemonaive. The mean age was 53 years (range 35-72). The median number of cooling session was 5 (1-12). 70% of patientsreceived anthracycline-based polichemotherapy (ac or fec 75 every three weeks) and 30% received monotherapy with taxanes on weekly schedule. Alopecia G0 and G1 were registered at the end of chemoterapy in 62% of the patients,irrespective of the type of treatment . 100% of these patients reported to be satisfied in terms of hair preservation during their last session. 27% of patients discontinued scalp coolingtreatment because of severe alopecia (G2); all these patients were receiving anthracycline. Scalp cooling was stopped because of intolerance in 11% of patients mainly due to discomfort and longer time of infusion. Conclusion: The Paxman scalp cooler was found to be an effective technique with moderate side-effects for patients treated with commonly prescribed alopecia-inducing chemotherapy drugs.Lengthening infusion time seems to be the main limit of this system.

The dermal papilla: an instructive niche for epithelial stem and progenitor cells in development and regeneration of the hair follicle.

The dermal papilla (DP) of the hair follicle is both a chemical and physical niche for epithelial progenitor cells that regenerate the cycling portion of the hair follicle and generate the hair shaft. Here, we review experiments that revealed the importance of the DP in regulating the characteristics of the hair shaft and frequency of hair follicle regeneration. More recent work showed that the size of this niche is dynamic and actively regulated and reduction in DP cell number per follicle is sufficient to cause hair thinning and loss. The formation of the DP during follicle neogenesis provides a context to contemplate the mechanisms that maintain DP size and the potential to exploit these processes for hair preservation or restoration.

Why scalp cooling in breast cancer?

*Lissevenlaan 13 5582 KB Waalre, The Netherlands; Tel.: +31 40 221 3807; wimbreed@online.nl

Hair-Preservation Craniotomy for Skull Base Procedures

Introduction: Cosmetic outcome is an important factor in postoperative patient satisfaction. Craniotomy with hair preservation provides cosmetic benefit, and has been shown to be equivalent to wide hair clipping in regards to surgical site infection incidence following general adult and pediatric transcranial neurosurgical procedures. Relatively fewer studies have evaluated the safety of hair preservation in transcranial skull base procedures, but the available evidence strongly suggests no additional operative risk. Despite patient-centered benefits and demonstrated equivalent risk, hair-preservation techniques have only been partially adopted by the neurosurgical community. Reported reasons for continued wide hair clipping include better access to the incision site and the persistent belief that hair preservation is associated with increased infection rates. The objectives of this study were to (1) evaluate skull base procedures performed via hair-preservation craniotomy for surgical site infections, (2) add to the existing body of evidence, and (3) increase awareness of hair preservation as a potential option for skull base surgical procedures.

Abstract P2-12-12: Efficacy and safety of scalp cooling (SC) treatment for alopecia prevention in women receiving chemotherapy (CTX) for breast cancer (BC).

Abstract Background: CTX induced hair loss (HL) is one of the most distressing side effects of BC treatment. Compared to women without CTX induced alopecia, those with alopecia have reported poorer body image, lower self-esteem and worse quality of life. In some cases, CTX induced HL may affect choice of therapy. Given the emotional impact of HL, the potential benefit of preventing CTX induced alopecia is great. We conducted a registry study tracking safety and efficacy in BC patients (pts) treated at our center who independently elected to use Penguin Cold Cap Therapy (PCCT). Methods: Pts who chose to use PCCT during CTX for early stage (ES) or advanced (M) disease signed informed consent to participate in the registry. HL was rated by practitioner assessment using the 5 point Dean's scale for HL: grade 0 (no HL), 1 (&amp;lt; 25% HL), 2 (25–50% HL), 3 (50–75% HL), and 4 (&amp;gt;75% HL), and by pt assessment using a visual analogue scale (VAS) from 0–100 where 0 = no HL and 100 = 100% HL. Assessments were every 2–3 weeks at the start of each CTX cycle, and once in follow-up 1–6 months after completing CTX. Additional data collected included pt reported adverse events and pt satisfaction with the success, ease of use, and tolerability of PCCT. Results: 31 pts (29 with ES and 2 with M disease) have registered. 25 have completed CTX and 20/25 are off study. 6 pts currently on CTX and 2 pts who stopped PCCT after cycle1 due to toxicity of CTX rather than issues with PCCT were excluded from the safety and efficacy analyses due to incomplete data. 2 additional pts were excluded from efficacy analysis due to beginning PCCT after the start of CTX, leaving 21 pts evaluable for efficacy and 23 pts for toxicity. CTX regimens included: docetaxel and cyclophosphamide (TC), docetaxel, carboplatin and trastuzumab (TCH), sequential doxorubicin and cyclophosphamide and paclitaxel, (AC/T), weekly nab-paclitaxel (nab). PCCT toxicities were all &amp;lt; grade 2 and included: 15 pts (71%) with headaches and 5 (22%) with dandruff during PCCT. All pts experienced head pain, and 20 pts (95%) had scalp pain and felt chilled during the PCCT. Table 1 depicts clinician and patient reported efficacy. Of the 20 pts assessed following completion of CTX and PCCT, 12 (60%) “highly recommend” PCCT, and 8 (40%) “recommend to some degree”. No ESBC pts have worn a wig at any point. Conclusions: SC treatment (PCCT) is a viable but variably effective method of preventing HL for ESBC pts receiving CTX. The success of SC in hair preservation was dependent on the type and length of CTX regimen. Other patient factors impacting HL may exist. Short term toxicity is minimal. Given the emotional impact of CTX induced HL, ongoing study of PCCT and other SC devices, comparing different CTX regimens, is worthwhile. Ongoing studies at our center will include independently graded photographs to eliminate reporting bias by the clinician. Support for this trial was provided by the Tauber Foundation. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-12.

Prospective cohort study of chemotherapy-induced alopecia with or without scalp cooling.

9138 Background: Scalp cooling can prevent chemotherapy-induced alopecia. Success varies according to the type of chemotherapy. A controversy exists regarding the use of scalp cooling because of the lack of efficacy data with modern chemotherapy regimen and safety data. We present a prospective cohort study design to measure alopecia. Methods: The prospective study was conducted at the Centre des Maladies du Sein Deschênes-Fabia (CMS) in Quebec City (where scalp cooling is offered routinely and 85% of women use it) and at the Centre Hospitalier Universitaire de Montreal (CHUM), in Montreal (where scalp cooling is not available). Women were eligible if they were going to receive neoadjuvant or adjuvant chemotherapy for breast cancer. The study involved completion of questionnaires (on degree of alopecia, hair type, hair care, use of head accessories, tolerance to scalp cooling and questions related to sick leave from work) and having pictures taken at baseline, cycle 3 and at the last cycle of chemotherapy. For the last 43 patients, the EORTC QLQ-C30/BR23 and an adaptation for Hairdex were added. Results: A total of 136 patients were recruited (110 at CMS over 2 years and 26 at the CHUM over a 9-month period). Preliminary efficacy results are shown in the Table (data on quality of life have not yet been analyzed). Hair preservation was defined as a SUCCESS for hair loss (since the beginning of chemotherapy) characterized as “not at all”, “a little” or “moderate” and “FAILURE” when characterized as “a lot” or “all” or “hair shaved”. Overall, in the scalp cooling group, 34% were considered a “success” using hairdresser evaluation and 49% using patient evaluation; for the non scalp-cooling group, these rates were 9% and 4% respectively. Conclusions: Scalp cooling appears to be efficacious for preventing chemotherapy-induced alopecia in this exploratory cohort study. [Table: see text]

Short post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia

The patient impact of chemotherapy-induced alopecia (CIA) is high. Scalp cooling is applied to reduce CIA. The potential optimum post-infusion cooling times (PICTs) are currently unknown. Scalp cooling was applied in 53 patients receiving docetaxel chemotherapy with 90-min PICT (observational part). Also 15 non-scalp-cooled patients were included. If hair preservation was observed in >80 % of the patients, randomisation between 45 and 90-min PICT was planned. Patients reported tolerance of scalp cooling and use of head covering. Observational study: 81 % of scalp-cooled patients did not require head covering versus 27 % of non-scalp-cooled patients. Randomised study: 79 % of 38 patients with 90-min PICT did not need head covering versus 95 % of 38 patients with 45-min PICT (p = 0.04). Scalp cooling was very well tolerated (visual analogue scale = 79). A 45-min PICT can be recommended in 3-weekly docetaxel regimens with a dose of 75 or 100 mg/m(2), administered in 60 min. The shorter PICT is a major advantage in time investment for patients. Patients (women and men) who receive docetaxel, except combined with doxorubicin and cyclophosphamide (taxotere, adriamycin and cyclophosphamide (TAC)) should be informed about the protective effect and high tolerability of scalp cooling in avoiding CIA.

Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients - Results of the Dutch Scalp Cooling Registry

Background. Chemotherapy-induced alopecia is a frequently occurring side effect of cancer treatment with a high psychological impact which can be prevented by scalp cooling. With this multi-centre patient series we estimated the results of scalp cooling for currently used chemotherapies to provide patient information and we identified characteristics associated with the results. Material and methods. The Dutch Scalp Cooling Registry collected data on scalp-cooled patients in 28 Dutch hospitals. Nurses and patients completed questionnaires on patients, chemotherapy and scalp cooling characteristics. Logistic regression analysis was used to examine associated characteristics of the scalp cooling result. Results. Overall, 50% of the 1411 scalp-cooled patients did not wear a head cover during their last chemotherapy session. Patients were satisfied with the results in 8% of cases after TAC chemotherapy and up to 95% after paclitaxel treatment. Besides type of chemotherapy, higher dose and shorter infusion time, older age, female gender and non-West-European type of hair significantly increased the proportion head cover use. Hair length, quantity, chemical manipulation (dyeing, waving, colouring), wetting hair before scalp cooling, and treatment with chemotherapy ever before did not influence the degree of head covering among patients. Conclusions. Scalp cooling results as recorded in this open patient registry were positive for most regimens, justifying it's use by all eligible patients, except for those needing TAC. Lengthening infusion time may improve the results.

Le lifting cervicofacial à double verrouillage

We report our favourite cervicofacial lift technique based on three principles: secondary undermining after subcutaneous canulation through two or three small incisions, a first lock at the level of any classic SMAS technique and a second subdermic lock after appropriate tension on the skin flap 1cm in front of the primary incision. We consider that this method provides the following advantages: safe undermining plane without any traction on the final scar, hair preservation, and a final natural looking consistent with the usual request in France. We therefore believe that this technique could be particularly useful for those whose experience is still limited. We report the survey of the 122 cases operated over the past five years without any major incident. Revision rate is 3.5%, but we believe it underestimates the quality of the results and efforts must be continued on the possible shortcomings of cheek ptosis, correction of naso labial fold and jowls. We recommend a medial approach for difficult necks and are reluctant to undermine extensively the mastoid area. We limit as much as possible malar lifts which recovery is sometimes difficult to manage, preferring the restoration of this area through lipofilling later complemented if necessary by one of the many fillers now available.

Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Dąbrowski T. Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia. 2011;15(2):95-101. doi:10.5114/wo.2011.21813. APA Dąbrowski, T. (2011). Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia, 15(2), 95-101. https://doi.org/10.5114/wo.2011.21813 Chicago Dąbrowski, Tomasz. 2011. "Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature". Contemporary Oncology/Współczesna Onkologia 15 (2): 95-101. doi:10.5114/wo.2011.21813. Harvard Dąbrowski, T. (2011). Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia, 15(2), pp.95-101. https://doi.org/10.5114/wo.2011.21813 MLA Dąbrowski, Tomasz. "Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature." Contemporary Oncology/Współczesna Onkologia, vol. 15, no. 2, 2011, pp. 95-101. doi:10.5114/wo.2011.21813. Vancouver Dąbrowski T. Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia. 2011;15(2):95-101. doi:10.5114/wo.2011.21813.

Scalp cooler efficacy to reduce anthracycline-induced alopecia and its QOL impact in breast cancer

e13539 Background: Hair loss is a common, unavoidable, and stressful side effect of chemotherapy. This work was performed to evaluate the role of scalp cooling in reducing anthracycline-induced hair loss and its impact on Quality of life (QOL). Methods: The study was conducted from July 2007 to August 2008. It included 120 females with breast cancer, treated in adjuvant setting. Patients were chosen according to certain criteria (age ≤ 70 years, WHO performance status 0–1, no cardiac disease, no serious psychiatric conditions, no previous chemotherapy). Patients were divided randomly into 2 groups according to whether scalp cooler was used or not during chemotherapy. Chemotherapy consisted of doxorubicin (50 mg/m2), 5-FU (500 mg/m2) and cyclophosphamide (500 mg/m2) for 6 cycles. Paxman Scalp Cooler was used. The cap was applied 20 minutes before, during and 2 hours after infusion. Hair loss was assessed using WHO criteria at each cycle and after 6 cycles of chemotherapy. QOL was assessed using EORTC QLQ-C30 and BR23. Results: After 4 cycle, 61.7 % of patients in scalp cooling group had grade 4 hair loss compared to 81.7 % of patients in control group. After 6 cycles, 85% of patients in scalp cooling group experienced grade 4 hair loss compared to 100% of patients in the control group. Only 9 patients (15%) in the scalp cooling group developed grade 1–2 hair loss. No significant relation was found between the degree of hair loss and the liver function tests. Most patients (73.3%) were comfortable during cooling. QOL scores were comparable between the two groups except for emotional functioning and body image. In the hair loss group, 71.2% of patients showed severe disturbance of emotional functioning and 54.1% of patients had moderate disturbance in body image. In hair preservation group (9 patients), 77.8% developed moderate disturbance of emotional functioning and all patients had mild disturbance in the body image. Conclusions: The role of scalp cooling is limited at the total dose of 300 mg/m2 doxorubicin. It may be more effective with fewer cycles or less aggressive drug combination. Hair loss affects various aspects of QOL, especially emotional functioning and body image. More time is needed to assess the long term effect of hair loss on QOL and the incidence of scalp metastasis in the two study groups. No significant financial relationships to disclose.