Scalp cooling with adjuvant/neoadjuvant chemotherapy for breast cancer and the risk of scalp metastases: systematic review and meta-analysis
- Study type
- Meta-analysis
- Design
- Systematic review and meta-analysis of longitudinal studies
- Sample size
- 1959 patients in the scalp cooling group and 1238 patients without scalp cooling (from 10 papers reporting the incidence of scalp metastases)
- Source
- Breast Cancer Res Treat · 2017
In plain words
Some people with breast cancer worry that using a cold cap or scalp cooling to prevent hair loss during chemotherapy could raise the risk of the cancer spreading to the scalp. This study brought together the results of several studies and found that spread to the scalp was rare in both groups, with or without scalp cooling. The analysis showed that scalp cooling does not increase the risk of scalp metastases. Be sure to talk to your doctor about using this method.
Key results
Treatment arms and regimens
Patients with breast cancer who used scalp cooling during chemotherapy to preserve hair (1959 patients; estimated mean follow-up 43.1 months).
Meta-analysis of multiple trials; doses and schedules differed between trials and no single dose is reported.
Patients with breast cancer who received chemotherapy without scalp cooling (1238 patients; estimated mean follow-up 87.4 months).
Source of the regimen details: Abstract of the paper (meta-analysis; no single dose or protocol)
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Patients treated with chemotherapy for breast cancer. Patients were matched by disease, type of treatment, absence of metastatic disease and sex. Of 24 full-text papers reviewed, 10 reported the incidence of scalp metastases over time in the presence of scalp cooling.
Endpoints
Primary endpoint: the effect of scalp cooling versus no scalp cooling on the risk (incidence) of scalp metastases in patients with breast cancer receiving chemotherapy.
Safety and side effects
The abstract reports no safety outcome other than the incidence of scalp metastases. The incidence of scalp metastases was low regardless of scalp cooling.
Clinical significance and place in guidelines
This meta-analysis reduces the concern that scalp cooling increases the risk of scalp metastases in patients with breast cancer receiving chemotherapy, because the incidence was low in both groups with no significant difference. However, the abstract gives no information on guideline adoption, and its status in clinical guidelines should be checked separately.
Limitations
The study is based on longitudinal studies and patient matching. The estimated mean follow-up differed markedly between the two groups (43.1 months with scalp cooling versus 87.4 months without). The number of scalp metastasis events was small and the confidence intervals are wide. Of 24 papers, only ten reported quantitative incidence data. In their conflict-of-interest statement, the authors declared ties to Dignitana (the maker of a scalp cooling device).
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.