Assessment and treatment outcomes of persistent radiation-induced alopecia in patients with cancer Journal Article
| Authors: | Phillips, G. S.; Freret, M. E.; Novetsky Friedman, D.; Trelles, S.; Kukoyi, O.; Freites-Martinez, A.; Unger, R. H.; Disa, J. J.; Wexler, L. H.; Tinkle, C. L.; Mechalakos, J. G.; Dusza, S. W.; Beal, K.; Wolden, S. L.; Lacouture, M. E. |
| Article Title: | Assessment and treatment outcomes of persistent radiation-induced alopecia in patients with cancer |
| Abstract: | Importance: Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. Objective: To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. Design, Setting, and Participants: A retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. Main Outcomes and Measures: The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Results: Of the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P <.001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient,-0.624; P =.01). The association between hair density and scalp radiation dose was not statistically significant (-0.381; P =.16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction. Conclusions and Relevance: Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA. © 2020 American Medical Association. All rights reserved. |
| Journal Title: | JAMA Dermatology |
| Volume: | 156 |
| Issue: | 9 |
| ISSN: | 2168-6068 |
| Publisher: | American Medical Association |
| Date Published: | 2020-09-01 |
| Start Page: | 963 |
| End Page: | 972 |
| Language: | English |
| DOI: | 10.1001/jamadermatol.2020.2127 |
| PUBMED: | 32756880 |
| PROVIDER: | scopus |
| PMCID: | PMC7407362 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2020 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work