current_onkologyСсыл­ка на PubMed | Ссылка на DOI

Ав­то­ры с долж­но­стя­ми и зва­ни­я­ми:
Fehr MK, Welter J, Sell W, Jung R, Felberbaum R.

Вы­ход­ные дан­ные
Epub 2016 Dec 21.

Ало­пе­ция вслед­ствие хи­мио­те­ра­пии яв­ля­ет­ся од­ним из наи­бо­лее рас­про­стра­нен­ных и пси­хо­ло­ги­че­ски му­чи­тель­ным по­боч­ным дей­стви­ем хи­мио­те­ра­пии, для про­фи­лак­ти­ки это­го со­сто­я­ния с 1970 го­дов при­ме­ня­ет­ся охла­жде­ние ко­жи во­ло­си­стой ча­сти го­ло­вы.

В пред­став­лен­ное про­спек­тив­ное ис­сле­до­ва­ние бы­ло вклю­че­но 55 жен­щин, по­лу­чав­ших неоадью­вант­ную, адь­вант­ную или пал­ли­а­тив­ную хи­мио­те­ра­пию. Це­лью ис­сле­до­ва­ния бы­ла оцен­ка эф­фек­тив­но­сти си­сте­мы сен­сор­но кон­тро­ли­ру­е­мо­го охла­жде­ния ко­жи во­ло­си­стой ча­сти го­ло­вы (DigniCap: Sysmex Europe GmbH, Norderstedt, Гер­ма­ния) в про­фи­лак­ти­ке ало­пе­ции вслед­ствие хи­мио­те­ра­пии у па­ци­ен­ток с ра­ком мо­лоч­ной же­ле­зы или ре­про­дук­тив­ной си­сте­мы по­лу­чав­ших от 1 до 7 ре­жи­мов хи­мио­те­ра­пии. Кли­ни­че­ская оцен­ка, опрос па­ци­ен­та для оцен­ки удо­вле­тво­рен­но­сти и тя­же­сти ало­пе­ции [(ВОЗ) сте­пень ток­сич­но­сти] про­во­ди­лись в на­ча­ле те­ра­пии каж­до­го цик­ла и по за­вер­ше­нии хи­мио­те­ра­пии.

Из 55 па­ци­ен­тов 78% про­шли про­це­ду­ру охла­жде­ния во­ло­си­стой ча­сти го­ло­вы плоть до окон­ча­ния хи­мио­те­ра­пии. В муль­ти­ва­ри­ант­ном ана­ли­зе бо­лее мо­ло­дые жен­щи­ны, еже­не­дель­но при­ни­мав­шие па­кли­так­сел или па­кли­так­сел-кар­бо­пла­тин ис­пы­ты­ва­ли ме­нее ин­тен­сив­ную ало­пе­цию. Ком­плекс­ный успеш­ный ис­ход (без укры­ва­ния го­ло­вы + ВОЗ 0/1 сте­пе­ни) на­блю­дал­ся у всех па­ци­ен­тов 50 лет и мо­ло­же при­ни­мав­ших 4 цик­ла до­це­так­сел-цик­ло­фос­фа­мид или 6 цик­лов па­кли­так­сел—кар­бо­пла­тин. И на­обо­рот, ало­пе­ция на­блю­да­лась у всех жен­щин, при­ни­мав­ших трой­ную по­ли­хи­мио­те­ра­пию (6 цик­лов до­це­так­сел-док­со­ру­би­цин-цик­ло­фос­фа­мид). Для жен­щин, при­ни­мав­ших по­ли­хи­мио­те­ра­пию в непре­рыв­ном ре­жи­ме (3 цик­ла флюу­ра­цил-эпи­ру­би­цин-цик­ло­фос­фа­мид) с по­сле­ду­ю­щи­ми 3 цик­ла­ми до­це­так­се­ла или 4 цик­ла­ми док­со­ру­би­цин-цик­ло­фос­фа­мид с по­сле­ду­ю­щи­ми 4 цик­ла­ми до­це­так­се­ла), в под­груп­пе воз­рас­та 50 лет и бо­лее мо­ло­до­го воз­рас­та охла­жде­ние при­ве­ло к успе­ху в 43% в срав­не­нии с 10% в под­груп­пе бо­лее стар­ших жен­щин, по­лу­чав­ших те же ре­жи­мы.

Воз­мож­но­сти охла­жде­ния во­ло­си­стой ча­сти го­ло­вы для про­фи­лак­ти­ки ало­пе­ции вслед­ствие хи­мио­те­ра­пии за­ви­сят от ре­жи­ма хи­мио­те­ра­пии и воз­рас­та па­ци­ен­тов.

Ключевые слова: алопеция после химиотерапии, рак молочной железы, рак яичников, сенсорно контролируемое охлаждение кожи волосистой части головы


TABLE I
Characteristics of the seven patients who terminated scalp cooling during chemotherapy because of hair loss

Cancer type Therapy type Age Chemotherapy regimen Average cooling time per treatment (hours) Cycles completed at cessation Gradea of alopecia at cessation
Breast Neoadjuvant 40 TACx6 4.5 3 3
Breast Adjuvant 50 TACx6 4.5 1 2
Breast Adjuvant 45 FECx3→Dx3 4.0 1 2
Breast Adjuvant 46 ACx4→Dx4 3.0 2 3
Breast Adjuvant 47 ACx4→Dx4 3.0 2 2
Breast Adjuvant 76 Weekly paclitaxelx16 3.0 2 2
Ovarian 60 Paclitaxel-carboplatinx6 5.5 1 3

aWorld Health Organization grading: 0 = none; 1 = minimal hair loss (0% to 25%); 2 = moderate, patchy alopecia (>25% to 75%); 3 = complete alopecia, but reversible (>75%); 4 = non-reversible alopecia (>75%). TAC = docetaxel 75 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; FEC = fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; D = docetaxel 100 mg/m2 every 3 weeks; AC = doxorubicin 60 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; weekly paclitaxel = 80 mg/m2 weekly; paclitaxel-carboplatin = paclitaxel 175 mg/m2 plus carboplatin 6 AUC (area under the curve) every 3 weeks.

TABLE II
Objective assessment of the effectiveness of scalp cooling at the end of chemotherapy or at cessation of cooling treatment

Chemotherapy regimen Patients (n) by gradea of alopecia Effectiveness (grades 0 and 1)
0 1 2 3 Total
FECx3→Dx3 or ACx4→Dx4 or ECx4→Px12 3 8 9 4 24 46%
Paclitaxel-carboplatinx6 3 5 1 2 11 73%
Weekly paclitaxelx16 2 2 1 0 5 80%
TCx4 2 2 1 1 6 67%
TACx6 0 1 0 3 4 25%
TOTAL 10 18 12 10 50 56%

aWorld Health Organization grading: 0 = none; 1 = minimal hair loss (0% to 25%); 2 = moderate, patchy alopecia (>25% to 75%); 3 = complete alopecia, but reversible (>75%); 4 = non-reversible alopecia (>75%). FEC = fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; D = docetaxel 100 mg/m2 every 3 weeks; AC = doxorubicin 60 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; EC = epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; P = paclitaxel 80 mg/m2 weekly; paclitaxel-carboplatin = paclitaxel 175 mg/m2 plus carboplatin 6 AUC (area under the curve) every 3 weeks; weekly paclitaxel = 80 mg/m2 weekly; TC = docetaxel 75 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; TAC = docetaxel 75 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks.

TABLE III
Subjective indicators of alopecia and patient satisfaction by chemotherapy regimen

Chemotherapy regimen Pts (n) Indicator [n (%)]
≥80 Satisfaction with cooling treatment Recommend to others No head scarf or wig used
FECx3→Dx3 or ACx4→Dx4 or ECx4→Px12 24 15 (63) 16 (67) 9 (38)
Paclitaxel-carboplatinx6 11 8 (73) 10 (91) 7 (64)
Weekly paclitaxelx16 5 4 (80) 3 (60) 4 (80)
TCx4 6 4 (67) 5 (83) 4 (67)
TACx6 4 1 (25) 2 (50) 0 (0)
TOTAL 50 32 (64) 36 (72) 24 (48)

FEC = fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; D = docetaxel 100 mg/m2 every 3 weeks; AC = doxorubicin 60 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; EC = epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; P = paclitaxel 80 mg/m2 weekly; paclitaxel-carboplatin = paclitaxel 175 mg/m2 plus carboplatin 6 AUC (area under the curve) every 3 weeks; weekly paclitaxel = 80 mg/m2 weekly; TC = docetaxel 75 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; TAC = docetaxel 75 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks.

TABLE IV
Effectiveness based on combined subjective and objective indicators, by chemotherapy regimen and age

Chemotherapy regimen «No head covering» and grade 0 or 1a alopecia [n/N (%)]
Overall ≤50 Years >50 Years
FECx3→Dx3 or ACx4→Dx4 or ECx4→Px12 7/24 (30) 6/14 (43) 1/10 (10)
Paclitaxel-carboplatinx6 7/11 (64) 4/4 (100) 3/7 (43)
Weekly paclitaxelx16 3/5 (60) 0/0 (0) 3/5 (60)
TCx4 3/6 (50) 1/1 (100) 2/5 (40)
TACx6 0/4 (0) 0/3 (0) 0/1 (0)
TOTAL 20/50 (40) 11/22 (50) 9/28 (32)

aWorld Health Organization grading: 0 = none; 1 = minimal hair loss (0% to 25%). FEC = fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; D = docetaxel 100 mg/m2 every 3 weeks; AC = doxorubicin 60 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; EC = epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2 every 3 weeks; P = paclitaxel 80 mg/m2 weekly; paclitaxel-carboplatin = paclitaxel 175 mg/m2 plus carboplatin 6 AUC (area under the curve) every 3 weeks; weekly paclitaxel = 80 mg/m2 weekly; TC = docetaxel 75 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks; TAC = docetaxel 75 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks.

FIGURE 1

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(A, B) Before and (C, D) after images of a 32-year-old breast cancer patient who underwent sensor-controlled scalp cooling (Digni-Cap: Sysmex Europe GmbH, Norderstedt, Germany) while receiving neoadjuvant chemotherapy consisting of 4 cycles of doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 every 3 weeks, followed by 4 cycles of docetaxel 100 mg/m2 every 3 weeks.


Sensor-controlled scalp cooling to prevent chemotherapy-induced alopecia in female cancer patients

Scalp cooling has been used since the 1970s to prevent chemotherapy-induced alopecia, one of the most common and psychologically troubling side effects of chemotherapy. Currently available scalp cooling systems demonstrate varying results in terms of effectiveness and tolerability.
For the present prospective study, 55 women receiving neoadjuvant, adjuvant, or palliative chemotherapy were enrolled. The aim was to assess the effectiveness of a sensor-controlled scalp cooling system (DigniCap: Sysmex Europe GmbH, Norderstedt, Germany) to prevent chemotherapy-induced alopecia in breast or gynecologic cancer patients receiving 1 of 7 regimens. Clinical assessments, satisfaction questionnaires, and alopecia evaluations [World Health Organization (who) grading for toxicity] were completed at baseline, at each cycle, and at completion of chemotherapy.
Of the 55 patients, 78% underwent scalp cooling until completion of chemotherapy. In multivariate analysis, younger women and those receiving paclitaxel weekly or paclitaxel-carboplatin experienced less alopecia. The compound successful outcome («no head covering» plus «who grade 0/1») was observed in all patients 50 years of age and younger receiving 4 cycles of docetaxel-cyclophosphamide or 6 cycles of paclitaxel-carboplatin. Conversely, alopecia was experienced by all women receiving triplet polychemotherapy (6 cycles of docetaxel-doxorubicin-cyclophosphamide). For women receiving sequential polychemotherapy regimens (3 cycles of fluorouracil-epirubicin-cyclophosphamide followed by 3 cycles of docetaxel or 4 cycles of doxorubicin-cyclophosphamide followed by 4 cycles of docetaxel), the subgroup 50 years of age and younger experienced a 43% success rate compared with a 10% rate for the subgroup pf older women receiving the same regimens.

The ability of scalp cooling to prevent chemotherapy-induced alopecia varies with the chemotherapy regimen and the age of the patient.

Keywords: Chemotherapy-induced alopecia; breast cancer; ovarian cancer; sensor-controlled scalp cooling