Final results of scalp cooling for hair preservation: A single- institution prospective study

Background The cancer treatments bring with it body image challenges, causing low self-esteem and contributing to worsen the quality of life. Chemotherapy (CT)-induced hair loss (HL) is one of the most emotionally distressing side effects of several breast cancer (BC) treatments. The DigniCap system (DCS), using the scalp cooling system, has been shown to reduce CT-induced alopecia (A) in a multicenter prospective trial. The purpose of this prospective observational study was to describe our experience. Methods Two DCS device are available at the Brindisi Oncology Dpt. From February 2016 and January 2019, 158 consecutive early stage BC pts who received anthracycline and/or taxane-based treatment were enrolled, post local Ethics Committees approval. A nurse and a psychologist were dedicated for these pts. Success of scalp cooling was defined according to the Dean’s scale: G0=no HL; G1 75% HL. Results A total of 158 women were included in the following treatment cohorts: n = 70 (44.30%) received 4 courses of EC (epirubicin at 90 mg/m2 and cyclophosphamide (c) at 600 mg/m2 intravenously (IV) on day 1, with 21 days between cycles) followed by 12 courses of paclitaxel (P) 80 mg/m2 IV once a week (w); n = 56 (35.4%) received only 4 courses of EC, n = 28 pts (17.7%) P (80 mg/m2 IV once a w) and concurrent trastuzumab (2 mg/Kg IV; loading dose 4 mg/kg) for 12 consecutive doses and n = 4 (2.6%) pts received 4 courses of TC (docetaxel at 75 at 90 mg/m2 and c at 600 mg/m2 IV on day 1, every three w. Median age was 49 years (range 31-74). Overall success was observed in 115 pts (72.8%). Full preservation of the hair (G0) was observed in 37 pts (23.4%), G1 in 47 pts (29.7%) and G2 in 31 pts (19.6%). Most frequent scalp cooling-related symptoms were coldness (n = 129, 81.6%), neck pain (n = 83, 52.2%) and headache (n = 113, 71.5%). Overall, 14.6% (n = 23) of pts discontinued DCS because of unsatisfactory hair preservation (n = 11, 7.0%) and cold discomfort (n = 12; 8.4%). Furthermore we observed a hair growth when DCS was continued for pts with A G3 – G4. Conclusions Our results confirmed and reinforced previous evidences, showing that DCS is a good chance to prevent A during CT with anthracycline and/or taxane-based regimen and supported the wider use to all women with early stage BC. Legal entity responsible for the study Saverio Cinieri. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.