SynthesisSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026
Comparative efficacy of interventions for preventing chemotherapy-induced alopecia: a systematic review and network meta-analysis.
Synthesis in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
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Abstract
purposeChemotherapy-induced alopecia (CIA) negatively affects patients' appearance and emotional well-being. This network meta-analysis aimed to compare the efficacy of different preventive interventions for CIA.
methodsWe searched PubMed, Embase, CENTRAL, and EBSCO Open Dissertations from inception to March 2025. Randomized controlled trials evaluating interventions to prevent CIA in cancer patients and reporting hair preservation outcomes (as defined by individual trials, including CTCAE grade < 2, < 30 to < 50% hair loss, or WHO grade 0-2) were included. Scalp hypothermia was divided into three groups based on duration post-chemotherapy: short (0-45 min), traditional (46-90 min), and prolonged (> 90 min). Risk of bias was assessed using Cochrane RoB2. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Interventions were ranked with surface under the cumulative ranking curve (SUCRA), and certainty of evidence was evaluated using CINeMA.
resultsOf 6696 articles identified, 12 (n = 736) evaluating nine interventions (three scalp hypothermia durations, scalp compression, four pharmacological agents, and usual care) were included. Network meta-analysis indicated that prolonged-scalp hypothermia significantly improved hair preservation compared with usual care (RR = 24.66; 95%CI = 7.07-86.05; low certainty of evidence) and traditional scalp hypothermia (RR = 2.13; 95%CI = 1.15-3.93; very low certainty of evidence), and pharmacological agents (RRs ranging from 14.06 to 23.83; low certainty). However, prolonged-scalp hypothermia tended to show better hair preservation than short duration, though not statistically significant (RR = 2.06, 95%CI = 0.78-5.39). Based on SUCRA, prolonged-scalp hypothermia (97.0%) had the highest ranking, followed by short scalp hypothermia (78.6%) and traditional scalp hypothermia (76.8%). Most studies were rated as having high risk of bias, and the certainty of evidence was graded as low to very low.
conclusionCurrent low certainty evidence suggests that scalp hypothermia could prevent CIA. Prolonged-scalp hypothermia provides a higher degree of protection, whereas a short duration demonstrates a weaker protective effect. However, this difference was not statistically significant.
trial registrationThis systematic review was registered in PROSPERO (registration number: CRD420251103932) and can be accessed via the following link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251103932 .
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.