Intensity Modulated Radiotherapy Appears to Prevent Hair Loss in Patients Treated for Brain Cancer:

Presented at ASTRO
By Ed Susman

DENVER, CO -- October  2005

Use of intensity modulated radiotherapy could prevent the hair loss that usually accompanies use of whole brain irradiation in palliation procedures to control metastases to the brain, according to a small study.

Todd Scarbrough, MD, Radiation Oncologist and Medical Director, Melbourne Internal Medicine Associates, Melbourne, Florida, United States, said that in a series of 14 patients who underwent the procedure, 6 have had no hair loss and the others maintained most of their hair.

"With standard whole brain irradiation using opposed lateral beams, virtually every patient lost 100% of their hair," Dr. Scarbrough said. "This is a quality of life issue."

"I describe their condition as having subjective mild hair loss. There is no standard scale for measuring hair loss," Dr. Scarbrough said in a poster presentation here on October 18th at the 47th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

Dr. Scarbrough said the standard treatment used in hopes of preventing spread of the brain metastases not only irradiates the brain but also the scalp, leading to profound hair loss.

"In a patient who has a limited life expectancy, loss of hair can be a devastating social and emotional consequence," he said. "We have found that it is not only women who are upset by the loss of their hair but men as well."

Dr. Scarbrough, who holds faculty positions at the University of Miami School of Public Health and at the University of Texas Health Science Center at San Antonio, said that instead of using the two-beam treatment, he offers his patients a multifield, computer-controlled conformal beam arrangement that can focus more radiotherapy on the areas where the lesions are located and limit radiation exposure to the scalp.

Theodore Lawrence, MD, professor and chair of radiation oncology at the University of Michigan, Ann Arbor, Michigan, commented, Use of intensity modulated radiation therapy is much more expensive than standard whole brain radiation."

"It may be difficult to sell to patients the idea that they might be able to protect their hair with a procedure that is both more expensive than the standard and unproven," Dr. Lawrence said.

The physics behind the concept are sound, he said, and there should be less of a dose of radiation to the scalp. Nevertheless, Dr. Lawrence said the treatment needs to be compared in a randomized trial to determine its true effectiveness.

Dr. Scarbrough said that if insurers cover the expense of palliation treatment for a person with late stage cancer, the companies will often pick up the cost of using the more expensive treatment. Not surprisingly, he said, patients prefer the treatment that will preserve their hair.