• Cryotherapy

  While Cryotherapy is not a common household term for a lot of Americans; Cryotherapy is medical technique that has been in use by a variety of practitioners and clinicians since the turn of the century. The word cryotherapy literally means “cold therapy.” It is the use of extreme cold as a form of treatment.

• Chemotherapy

  Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells. Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Hair loss typically can start after your first round of chemotherapy on or about the second week after your first cycle. Side effects often get better or go away after you have finished chemotherapy.

Research conducted on patients being treated with cold caps (cryotherapy gel caps) receiving IV chemotherapy shows as follows.

Of those who wore a cap consistently cooled to 32 degrees for 30 minutes before their chemotherapy treatment, throughout every chemo session, and for 90 to 120 minutes afterward, MORE THAN HALF experienced hair loss of 50 percent or LESS That was compared to another group of patients undergoing chemotherapy that did not use the caps.

THE RESULTS ARE IN

Published online 2019 Aug 6. doi: 10.3389/fonc.2019.00733

PMCID: PMC6691158

PMID: 31448235

Efficacy of Scalp Cooling in Preventing and Recovering From Chemotherapy-Induced Alopecia in Breast Cancer Patients: The HOPE Study

Purpose: This study aimed to assess the efficacy of scalp-cooling devices in preventing chemotherapy-induced alopecia in Japanese breast cancer patients and investigate whether a scalp-cooling device improves hair volume recovery over a 12 weeks period after completing chemotherapy.

Methods: This multicenter controlled trial included women with breast cancer undergoing chemotherapy in Japan between February 2016 and March 2018. The primary endpoint was the proportion of patients with no alopecia at the end of chemotherapy. The secondary endpoint included hair volume at 12 weeks after completing chemotherapy.

Results: A total of 48 patients were enrolled; of them, 34 and 14 were sequentially allocated to the scalp-cooling group using the Paxman Hair Loss Prevention System and the control group, respectively. There was no significant difference in average age between the scalp-cooling and the control groups (50.0 ± 9.6 vs. 49.0 ± 9.0 years). More than 50% of patients in each group had stage II breast cancer (scalp-cooling group: 53.1%; control group: 64.3%), more than 90% received adjuvant chemotherapy (scalp-cooling group: 96.9%; control group: 92.9%), and more than 60% were treated with a docetaxel/cyclophosphamide regimen (scalp-cooling group: 75.0%; control group: 64.3%). There were more patients judged to have no alopecia at the end of chemotherapy in the scalp-cooling group than in the control group (26.7% [8/30] vs. 0% [0/13]; P = 0.011). The proportion of patients with alopecia who experienced an increase in hair volume of ≥50% within 12 weeks duration after chemotherapy was 85.7% (24/28) in the scalp-cooling group and 50.0% (6/12) in the control group. No patient developed serious adverse events related to the scalp-cooling device.

Conclusions: The use of a scalp-cooling device prevented alopecia with acceptable safety for Japanese patients. In addition, scalp cooling resulted in faster recovery of hair volume after chemotherapy, even in patients for whom scalp cooling failed to prevent chemotherapy-induced alopecia.

Keywords: scalp cooling, chemotherapy-induced alopecia, breast cancer, hair loss, hair volume recovery, anthracycline, docetaxel, side effects

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Introduction

Breast cancer is the commonest cancer in women in Japan, with an incidence of more than 80,000 in 2013 (1). Despite the various adverse reactions, adjuvant chemotherapy is still commonly used for the treatment of breast cancer. Of these reactions, alopecia is among the most distressing for patients (2, 3) and ~8% of patients with breast cancer choose alternative medication to avoid alopecia (4). Although alopecia is not directly life-threatening, it carries a significant psychological burden.

Scalp cooling has been investigated as a method for minimizing alopecia since the 1970s, and advancements in scalp-cooling methods have been made in European countries (5). For example, treatment with a frozen cooling cap has been enhanced by the development of a method to continuously circulate coolant inside the cap so that it no longer needs to be replaced. Two recent prospective clinical studies in the US demonstrated that scalp cooling inhibited alopecia, and two sustained scalp-cooling devices have been approved by the US Food and Drug Administration (6, 7). Scalp cooling is currently the commonest method to reduce chemotherapy-induced alopecia. A meta-analysis of chemotherapy-induced alopecia showed that the use of scalp cooling reduced the risk of alopecia (Relative risk: 0.38, 95% CI: 0.32–0.45), and the rate of hair preservation vary from 10 to 100%, depending on factors, such as chemotherapy regimen, scalp-cooling method, scalp-cooling temperature, and definition of hair preservation (8, 9). According to the latest literature, scalp cooling is more likely to be successful for taxane-based chemotherapy than anthracycline-based chemotherapy (59 vs. 16%) (6).

There are currently two proposed mechanisms for the inhibition of alopecia by scalp cooling. First, cooling constricts blood vessels and reduces blood flow to follicle cells, which may reduce the amount of chemotherapy drug delivered to them. Second, cooling reduces the metabolic activity of follicle cells, which may reduce the cytotoxicity of the chemotherapy agent (10). Meanwhile, it has long been debated whether scalp cooling can preserve cancer cells in cases of micrometastasis prior to cooling (11). However, a recent meta-analysis by Rugo et al. showed that the incidence of scalp metastasis in breast cancer patients is very low, irrespective of cooling, and that cooling does not increase its risk (12).

A recent clinical study based in Japan assessed the efficacy of a scalp-cooling equipment (Paxman Hair Loss Prevention System, UK) and found that scalp cooling reduced the incidence of alopecia after chemotherapy in Japanese patients with breast cancer (13). To build on this finding, the current comparative study aimed to evaluate the safety and efficacy of the Paxman Hair Loss Prevention System in patients with breast cancer. As a secondary endpoint, hair volume was evaluated 12 weeks after chemotherapy termination.

Kinoshita T, Nakayama T, Fukuma E, Inokuchi M, Ishiguro H, Ogo E, Kikuchi M, Jinno H, Yamazaki N, Toi M. Efficacy of Scalp Cooling in Preventing and Recovering From Chemotherapy-Induced Alopecia in Breast Cancer Patients: The HOPE Study. Front Oncol. 2019 Aug 6;9:733. doi: 10.3389/fonc.2019.00733. PMID: 31448235; PMCID: PMC6691158.

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