Manon M C Komen1, Corina J G van den Hurk2, Johan W R Nortier3, Tjeerd can der Ploeg4, P Nieboer5, Jacobus J M van der Hoeven6, Carolien H Smorenburg7
1Department of Internal Medicine and Medical Oncology, Medical Centre Alkmaar, PO Box 501, AM, 1800, Alkmaar, The Netherlands.
2Comprehensive Cancer Organisation the Netherlands, PO Box 19079, DB, 3501, Utrecht, The Netherlands.
3Department of Medical Oncology, Leiden University Medical Centre, PO Box 9600, RC, 2300, Leiden, The Netherlands.
4Business, Finance and Law department, Inholland Alkmaar, PO Box 501, AM, 1800, Alkmaar, The Netherlands.
5Department of Medical Oncology, Wilhelmina Ziekenhuis Assen, Europaweg-Zuid 1, RK, 9401, Assen, The Netherlands.
6Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, GA, 6525, Nijmegen, The Netherlands.
7Department of Medical Oncology, Antoni van Leeuwenhoek, Plesmanlaan 121, CX, 1066, Amsterdam, The Netherlands.
Scalp cooling as a method to reduce the incidence of chemotherapy-induced alopecia (CIA) is increasingly used in daily practice worldwide. However, in patients treated with 5-fluorouracil, epirubicin and cyclophosphamide (FEC), scalp cooling fails in 48-67% of patients. This study investigated the efficacy of extended duration of post-infusion scalp cooling in breast cancer patients treated with this regimen.
This prospective, multi-centre, randomised study in the Netherlands aimed to determine if increasing the post-infusion cooling time by 1 hour improved hair retention efficacy for breast cancer patients on FEC chemotherapy regimens. The patients’ hair was assessed against the World Health Organisation’s (WHO) scale for alopecia (0 = no change; 1 = minimal hair loss; 2 = moderate hair loss; 3 = complete alopecia). Patients also assessed their tolerance to the treatment against a visual analogue scale (10 = most tolerable). Patient’s headaches were also reported.
Method of scalp cooling: Paxman Scalp Cooler (PSC-1).
Type of Chemotherapy: FEC with an epirubicin dose of 90-100mg/m2. Patients: 102 female breast cancer patients prescribed adjuvant FEC chemotherapy regimens. Half of the patients were assigned a post-infusion time of 90 minutes and the other half were assigned 150 minutes.
No significant difference was found between the 90- and 150-minute groups with respect to wig/head cover usage, however, the 150- minute group showed a significantly higher proportion of patients with grade 0-1 alopecia on the WHO scale. The dosage of chemotherapy (90 vs 100mg/m2) and the number of cycles (3, 5 or 6) did not significantly affect the percentage of patients needing to use a wig/head cover. Tolerability: Scalp cooling was tolerated well by most patients. The mean VAS score was 7.4 (10 being the most comfortable). Three patients discontinued scalp cooling due to intolerance. Headaches were mentioned in 327 chemotherapy sessions, patients graded the severity. No cases of scalp metastases were reported during the follow up time (median 47 months).
This study may have been underpowered to detect a small difference in efficacy between the drug regimen groups. The significance between post-infusion times should be further investigated on a larger scale before it is adopted into practice.
