Radiation-Induced Alopecia in Patients Undergoing Intracranial Radiation Therapy: A Systematic Review.
Mostafa Jafari, Sare Hosseini, Reza Taleei et al.
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In 30 seconds
This PRISMA-guided systematic review examined radiation-induced alopecia (RIA) in patients receiving external-beam cranial or head-and-neck radiotherapy. Fifteen studies, covering approximately 1,500 patients and multiple radiation techniques, were included. Scalp dose measures, particularly near-maximum dose and volumetric parameters, were consistently associated with RIA severity. Temporary alopecia typically occurred at ∼20 Gy, while permanent alopecia was reported at mean doses above 30 to 36 Gy or D2% doses of approximately 45 to 50 Gy. Predictive models and scalp-sparing approaches were also assessed.
Key findings
- Temporary RIA typically occurred at ∼20 Gy; permanent RIA was observed at mean doses above 30 to 36 Gy or D2% doses approximately 45 to 50 Gy.
- Proton NTCP and gEUD models showed predictive performance with AUC 0.8 to 0.9 and external validity.
- Pediatric patients, particularly those receiving craniospinal irradiation with intensive chemotherapy, experienced permanent RIA at lower dose thresholds (∼21 Gy).
- Scalp-avoidance VMAT and hippocampus-sparing WBRT reduced scalp dose and preserved hair without compromising tumor control.
Why it matters
RIA can be temporary or permanent and may substantially affect self-image and quality of life. The review links alopecia severity to scalp dose and identifies dose ranges that can inform risk discussions. It also highlights potential roles for predictive modeling and scalp-sparing planning, while noting that patient-reported outcomes remain infrequently assessed.
What to keep in mind
Patient-reported outcomes were infrequently assessed across the included studies.