Efficacy of Scalp Cooling in Chemotherapy

Introduction to Scalp Cooling Efficacy

• The European Society for Medical Oncology recommends scalp cooling as a method to prevent chemotherapy-induced alopecia, with a success rate of 50-65% of patients developing only mild hair loss 1, 3
• The efficacy of scalp cooling is reduced in anthracycline-based regimens, such as those including Epirubicin, especially when combined with other substances like Taxanes or Cyclophosphamide 2, 4

Mechanism and Application of Scalp Cooling

• Scalp cooling works through vasoconstriction and reduction of biochemical activity in the scalp and hair follicles 4, 5
• The protocol for scalp cooling includes:
  • Initiation of cooling 20-45 minutes before chemotherapy infusion 6
  • Continuation during infusion 6
  • Continuation for 20-150 minutes after infusion 4, 6

Safety and Contraindications

• Contraindications for scalp cooling include:
  • Hematological malignancies 7
  • Cold sensitivity 7
  • Cold agglutinin disease 7
  • Cryoglobulinemia 7
  • Cryofibrinogenemia 7
  • Cold post-traumatic dystrophy 5
  • Whole brain radiation after chemotherapy 4, 6
• Regarding safety, the incidence of scalp metastases in breast cancer patients with scalp cooling was 0.61% compared to 0.41% without scalp cooling, with no difference in survival 4, 5

Alternative and Supportive Measures

• After completion of chemotherapy, topical Minoxidil 5% can support hair regrowth 4, 7
• The use of Biotin (2.5 mg or 2500 mg daily) or Orthosilicic acid (10 mg daily) may be considered, but is not generally recommended 4, 8
• Checking TSH, Vitamin D, Zinc, and Ferritin serum levels and correcting corresponding deficiencies can be helpful 4, 5