Results of scalp cooling during anthracycline containing chemotherapy depend on scalp skin temperature

Breast. 2016 Dec:30:105-110. doi: 10.1016/j.breast.2016.09.007. Epub 2016 Sep 28.


Objectives: The success of scalp cooling in preventing or reducing chemotherapy induced alopecia (CIA) is highly variable between patients undergoing similar chemotherapy regimens. A decrease of the scalp skin temperature seems to be an important factor, but data on the optimum temperature reached by scalp cooling to prevent CIA are lacking. This study investigated the relation between scalp skin temperature and its efficacy to prevent CIA.

Materials and methods: In this explorative study, scalp skin temperature was measured during scalp cooling in 62 breast cancer patients undergoing up to six cycles of anthracycline containing chemotherapy. Scalp skin temperature was measured by using two thermocouples at both temporal sides of the head. The primary end-point was the need for a wig or other head covering.

Results: Maximal cooling was reached after 45 min and was continued for 90 min after chemotherapy infusion. The scalp skin temperature after 45 min cooling varied from 10 °C to 31 °C, resulting in a mean scalp skin temperature of 19 °C (SEM: 0,4). Intrapersonal scalp skin temperatures during cooling were consistent for each chemotherapy cycle (ANOVA: P = 0,855). Thirteen out of 62 patients (21%) did not require a wig or other head covering. They appeared to have a significantly lower mean scalp skin temperature (18 °C; SEM: 0,7) compared to patients with alopecia (20 °C; SEM: 0,5) (P = 0,01).

Conclusion: The efficacy of scalp cooling during chemotherapy is temperature dependent. A precise cut-off point could not be detected, but the best results seem to be obtained when the scalp temperature decreases below 18 °C. TRIALREGISTER.

Nl ntr number: 3082.

Keywords: Alopecia; Chemotherapy; Scalp cooling; Scalp temperature.

MeSH terms

  • Adult
  • Aged
  • Alopecia / chemically induced
  • Alopecia / prevention & control*
  • Anthracyclines / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Breast Neoplasms / drug therapy*
  • Cryotherapy / methods*
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Doxorubicin / adverse effects
  • Epirubicin / administration & dosage
  • Epirubicin / adverse effects
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Middle Aged
  • Scalp*
  • Skin Temperature*


  • Anthracyclines
  • Epirubicin
  • Doxorubicin
  • Cyclophosphamide
  • Fluorouracil