Prolonged scalp hypothermia improves hair preservation in cancer patients compared to usual care and traditional methodsLonger scalp cooling helps cancer patients keep more hair

PURPOSE: Chemotherapy-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. METHODS: We 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. RESULTS: Of 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. CONCLUSION: Current 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 REGISTRATION: This 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 .