Study: Characteristics, Treatment of Radiation-Induced Alopecia in Patients with Certain Cancers

Researchers of a study published in JAMA Dermatology characterized persistent radiation-induced alopecia (pRIA) in patients with primary central nervous system tumors (CNS) or head and neck sarcomas and provided treatment options.

In this retrospective cohort study, researchers evaluated 71 children and adults diagnosed with primary CNS tumors or head and neck sarcomas for pRIA at two large tertiary care hospitals and comprehensive care cancer centers between January 2011 and January 30, 2019. The primary outcomes were defined as 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.

According to the results, the average estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (OR= 1.15; 95% CI, 1.04 to 1.28) and proton irradiation (OR=5.7; 95% CI, 1.05 to 30.8) which was linked with with greater alopecia severity (P < .001), the researchers noted. They observed that the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7 to 39.6 Gy).

The researchers wrote that of the characteristics, “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.”


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 researchers authors concluded. “The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.”