Network meta-analysis finds prolonged scalp hypothermia may preserve hair during chemotherapy

A network meta-analysis of 12 randomized controlled trials involving 736 cancer patients found that prolonged scalp hypothermia was associated with better hair preservation during chemotherapy than usual care, traditional-duration scalp hypothermia, and four pharmacological interventions. The evidence was rated low certainty for the comparisons with usual care and pharmacological agents and very low certainty for the comparison with traditional scalp hypothermia.

The review compared nine preventive interventions: three durations of scalp hypothermia, scalp compression, four pharmacological agents, and usual care. The analysis included trials reporting hair-preservation outcomes such as CTCAE grade below 2, hair loss below 30% to below 50%, or WHO grade 0–2. The researchers searched PubMed, Embase, CENTRAL, and EBSCO Open Dissertations from database inception through March 2025. Risk ratios were pooled with a random-effects model, interventions were ranked using the surface under the cumulative ranking curve (SUCRA), and certainty was evaluated with CINeMA.

For prolonged scalp hypothermia, defined in the review as more than 90 minutes after chemotherapy, the pooled risk ratio for improved hair preservation was 24.66 compared with usual care (95% confidence interval, 7.07–86.05). The corresponding risk ratio was 2.13 compared with traditional scalp hypothermia lasting 46–90 minutes (95% CI, 1.15–3.93). Prolonged scalp hypothermia also produced better hair-preservation results than the four pharmacological agents, with risk ratios ranging from 14.06 to 23.83. The evidence for these comparisons was graded as low certainty. A comparison with short-duration scalp hypothermia, lasting 0–45 minutes, favored prolonged treatment numerically, but was not statistically significant: RR 2.06 (95% CI, 0.78–5.39).

The SUCRA ranking placed prolonged scalp hypothermia highest at 97.0%, followed by short-duration scalp hypothermia at 78.6% and traditional scalp hypothermia at 76.8%. These rankings indicate the ordering generated by the network analysis, but the review’s authors noted that most included studies had a high risk of bias and that the certainty of evidence ranged from low to very low. The abstract therefore supports the conclusion that scalp hypothermia could prevent chemotherapy-induced alopecia, while the difference between prolonged and short treatment was not statistically established. The review was registered in PROSPERO as CRD420251103932.

Subject of Research: Comparative effectiveness of interventions for preventing chemotherapy-induced alopecia

Article Title: Comparative efficacy of interventions for preventing chemotherapy-induced alopecia: a systematic review and network meta-analysis

Article References: Boonpattharatthiti, K., Lawin, S., Limhengsin, P., Dhippayom, T., & Danwilai, K. (2026). Comparative efficacy of interventions for preventing chemotherapy-induced alopecia: a systematic review and network meta-analysis. Supportive Care in Cancer, 34(11), Article 1123. https://doi.org/10.1007/s00520-026-11354-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11354-x

Keywords: chemotherapy-induced alopecia, scalp hypothermia, network meta-analysis, randomized controlled trials, hair preservation, systematic review, risk of bias, evidence certainty, Comparative, efficacy, interventions, preventing