Scalp cooling has long been a well-known technique to prevent hair loss. In 1996 in Great Britain, a machine was developed for the technique, which has a thermostat cooling system of glycol and water. The fluid circulates in a silicon cap placed on the head of the patient. Today there about 450 cooling cap machines in use, most of which are in Europe. Of these, about 60 are in the Nordic countries, 30-35 of which are in Norway. At Oslo University Hospital, 2-3 patients receive this treatment daily. A cooling machine reduces the temperature in the scalp to about 10 ºC using a cooling cap and is effective at preventing hair loss caused by chemotherapy of moderate intensity.
The mechanism of action appears to be partly vasoconstriction, but more importantly, temperature-dependent reduction of cellular uptake of chemotherapy drugs. Successful results are achieved with taxane.
The effect of cooling cap treatment is individual, but experience shows that most patients using this technique are able to avoid using a wig.
In order for the patient to gain the optimal effect of cooling treatment, it must be applied from the first to the last treatment. Since not all patients receive chemotherapy at Oslo University Hospital, it must be determined whether the patient can receive scalp cooling treatment during all chemotherapy courses before starting. Some patients apply for treatment at a hospital where they know scalp cooling treatment is available.
To what degree scalp cooling affects the temperature conditions in the bone marrow of the cranium does not appear to be sufficiently documented. In the literature, concern has been expressed that cooling may conserve micrometastases in the scalp; however, documentation of this is scarce. Due to this lack of documentation, Oslo University Hospital has decided that scalp cooling treatment is not recommended during chemotherapy with curative intention for cancers where micrometastases in the scalp or bone marrow is a problem (breast cancer, malignant lymphoma, leukemia).
For palliative chemotherapy however, it appears the method is acceptable as well as for chemotherapy with curative intention for cancer where metastasis to the skin, subcutis or bone marrow is uncommon.
For gynecological cancers, bone metastases are very rare. Scalp cooling is therefore not contraindicated during chemotherapy for such cancers. For many women, hair loss is significant for their self image. We recommend offering gynecological cancer patients the option of scalp cooling to prevent hair loss during chemotherapy.
- Prevent chemotherapy-induced hair loss (alopecia).