Prevention of doxorubicin-induced alopedia by scalp hypothermia: relation to degree of cooling.

Gregory, R P; Cooke, TG; Middleton, Janice; Buchanan, R. B.; Williams, Cori

doi:10.1136/bmj.284.6330.1674

Cited by 56 publications

(41 citation statements)

References 4 publications

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“…Two studies have shown that the efficacy of the hypothermic methods is inversely associated with epi-and subcutaneous scalp temperatures [7,13,18]. Based on these studies, a pre-and postchemotherapy scalp-cooling system has been used to maintain steady, low scalp temperatures.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy

Protière

Evans

Camerlo

et al. 2002

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The applicability and efficacy of a scalp cooling system were studied in 105 breast cancer patients receiving four cycles of adjuvant chemotherapy with mitoxantrone + cyclophosphamide (NC chemotherapy). Women accepting the scalp-cooling system were compared for alopecia both against those who refused and against a "reference" group of 109 patients similarly treated but without being offered a scalp-cooling system. Hair loss in the 105 study patients was evaluated by nurses using World Health Organization (WHO) criteria at each cycle of chemotherapy. Concomitantly, tolerance and side-effects of the helmet were also recorded in 48 accepting patients. Similarly to reference group patients, a subsample of 27 accepting patients self-assessed hair loss using a specific questionnaire measuring its frequency and severity and the distress associated with this symptom. Nurses' ratings ( n = 105) indicated that hair loss frequency was constantly lower, at each cycle of chemotherapy, in study patients with scalp-cooling system ( n = 77) than in those without ( n = 28). Differences between the two groups were statistically significant at cycles 1 and 3 ( P < 0.05). When compared with those reported by reference group patients ( n = 109), study patients' self-measures of alopecia frequency ( n = 27) provided even more marked results than those achieved by nurses (cycles 1-3: P < 0.01; cycle 4: P < 0.05). Tolerance was generally good and no scalp metastasis was observed among the 77 accepting patients followed up. This study demonstrates that scalp cooling was an effective method of protection against hair loss caused by NC chemotherapy. Its routine use as part of adjuvant chemotherapy, especially in cancers with low prevalences of scalp metastasis, should be seriously considered.

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Section: Discussionmentioning

confidence: 99%

Efficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy

Protière

Evans

Camerlo

et al. 2002

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“…Despite the lack of appropriate clinical data to formally demonstrate the precise temperature conditions that determine the efficacy of cooling, it has previously been suggested by various studies that a scalp temperature of 22 °C or less is required for hair preservation during chemotherapy (Gregory et al, 1982) (and reviewed in (Komen et al, 2013)), whilst we have evidence that a scalp temperature <16 °C can be achieved during cooling with commercially available scalp cooling devices, yet not all subjects undergoing scalp cooling can achieve this potentially critical temperature threshold (Hussain et al, unpublished observations). Thus, the ability to reach a temperature low enough to achieve cytoprotection may hold the key in determining the success of scalp cooling in preventing CIA in the clinic.…”

Section: Discussionmentioning

confidence: 99%

Use of in vitro human keratinocyte models to study the effect of cooling on chemotherapy drug-induced cytotoxicity

Al-Tameemi

Dunnill

Hussain

et al. 2014

Toxicology in Vitro

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A highly distressing side-effect of cancer chemotherapy is chemotherapy-induced alopecia (CIA). Scalp cooling remains the only treatment for CIA, yet there is no experimental evidence to support the cytoprotective capacity of cooling. We have established a series of in vitro models for the culture of human keratinocytes under conditions where they adopt a basal, highly-proliferative phenotype thus resembling the rapidly-dividing sub-population of native hair-matrix keratinocytes. Using a panel of chemotherapy drugs routinely used clinically (docetaxel, doxorubicin and the active metabolite of cyclophosphamide 4-OH-CP), we demonstrate that although these drugs are highlycytotoxic, cooling can markedly reduce or completely inhibit drug cytotoxicity, in agreement with clinical observations. By contrast, we show that cytotoxicity caused by specific combinatorial drug treatments cannot be adequately attenuated by cooling, supporting data showing that such treatments do not always respond well to cooling clinically. Importantly, we provide evidence that the choice of temperature may be critical in determining the efficacy of cooling in rescuing cells from drug-mediated toxicity. Therefore, despite their reductive nature, these in vitro models have provided experimental evidence for the clinically-reported cytoprotective role of cooling and represent useful tools for future studies on the molecular mechanisms of cooling-mediated cytoprotection. Chemotherapy-induced alopecia (CIA) is the most common and distressing side effect of anticancer chemotherapy (Wang et al., 2006) and the anxiety caused by the prospect of CIA can cause patients to even refuse treatment in certain cases (Munstedt et al., 1997). Thus development of an effective CIA preventative regime represents an important challenge in oncology (Paus et al., 2013). CIA occurs due to damage to the hair follicles, which comprise various cell types including hair matrix keratinocytes, which represent the most rapidly dividing cell subset and contribute to follicular structure and function (Roh et al., 2005). As chemotherapeutic drugs such as taxanes (e.g. docetaxel), alkylating agents (e.g. cyclophosphamide) and anthracyclines/DNA intercalating agents (e.g. doxorubicin) target cancer cells due to their rapid division rate, these drugs also target the matrix keratinocytes which results in hair loss (Paus et al., 2013). AbbreviationsCurrently the only available preventative treatment for CIA is head (scalp) cooling. Scalp cooling or hypothermia during the administration of chemotherapy drugs can substantially reduce hair loss (Protiere et al., 2002) and has been used since the 1970s (Dean et al., 1979). Clinically it has been shown that scalp cooling can substantially reduce the incidence of hair loss in response to individual drugs, including cyclophosphamide, doxorubicin and cisplatin (Breed et al., 2011;van den Hurk et al., 2012). However, for combined treatment regimens, such as sequential treatment with docetaxel (taxotere), doxorubicin (adriamycin) an...

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“…Temperature adjustment may prove a desirable feature once the optimal scalp temperature level has been established. Previous studies have found that the successful prevention of alopecia depends on the temperature, and an intra-cutaneous temperature below 22°C has been recommended (9).…”

Section: Discussionmentioning

confidence: 99%

Scalp Hypothermia in the Prevention of Chemotherapy-Induced Alopecia

Johansen¹

1985

Acta Radiologica: Oncology

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Prevention of doxorubicin-induced alopedia by scalp hypothermia: relation to degree of cooling.

Cited by 56 publications

References 4 publications

Efficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy

Efficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy

Use of in vitro human keratinocyte models to study the effect of cooling on chemotherapy drug-induced cytotoxicity

Scalp Hypothermia in the Prevention of Chemotherapy-Induced Alopecia

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