Radiation-induced alopecia in patients with CNS or head and neck tumors

  • Phillips GS & al.
  • JAMA Dermatol
  • 5 Aug 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • Patients who have received radiation to the scalp for central nervous system (CNS) or head and neck tumors are likely to experience dose-dependent persistent alopecia.
  • Treatment with topical minoxidil may improve hair loss in a vast majority of such patients.

Why this matters

  • Around 60% of patients with CNS tumors and 30% with head and neck cancer receive radiation to the head.

Study design

  • The study included 71 children and adults with persistent hair loss following radiotherapy for primary CNS tumors (n=64) or head and neck sarcoma (n=7).
  • Funding: National Institutes of Health/National Cancer Institute Cancer Center. 

Key results

  • The odds of grade 2 hair loss increased by 15% for every 1 unit increase in radiation dose (OR, 1.15; P<.001>
  • Proton irradiation was associated with significantly higher odds of severe hair loss (OR, 5.7; P<.001>
  • The majority of patients (82%) treated with topical minoxidil showed a response during a median follow-up of 61 weeks.
  • Among patients for whom clinical images were available, 16% showed complete response. 
  • 2 patients showed improvement with hair transplant, and 1 showed complete response with hair reconstruction.

Limitations

  • Retrospective design.
  • Lack of complete data for standardized clinical photos, trichoscopy images, and radiotherapy treatment plans.