title: [Allow scalp cooling during adjuvant chemotherapy in patients with breast cancer; scalp metastases rarely occur].
abstract: OBJECTIVE
  To investigate the incidence of scalp metastases in high-risk breast cancer patients in order to assess whether caution is warranted with scalp cooling during adjuvant therapy.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  The incidence of scalp metastases and the disease course were studied in 885 very well evaluated high-risk breast cancer patients. These patients, who had at least four positive axillary lymph nodes, were treated in a randomised study with either classical chemotherapy, or the same chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (the so-called N4+ study).
  
  
  RESULTS
  After a median follow up of 110 months, 403 of the 885 patients (46%) had relapsed or developed metastases. 25 patients (3%) had developed skin metastasis; 4 of these patients (0.5%) had developed hairy scalp metastasis. The scalp metastases always occurred at the same time as or later than metastases elsewhere.
  
  
  CONCLUSIONS
  Scalp metastases occur with a very low frequency and not as the first sign of metastatic disease. It is therefore unlikely that scalp cooling (to prevent baldness) decreases the local working of chemotherapy to such an extent that the risk of scalp metastases increases.
authors.affiliation: Leids Universitair Medisch Centrum, afd. Klinische Oncologie, the Netherlands.
authors.forename: Mariska A E
authors.initials: MA
authors.lastname: van de Sande
authors.forename: Corina J G
authors.initials: CJ
authors.lastname: van den Hurk
authors.forename: Wim P M
authors.initials: WP
authors.lastname: Breed
authors.forename: J W R Hans
authors.initials: JW
authors.lastname: Nortier
mesh_terms: D000505:Alopecia / Q000517:prevention & control*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000517:prevention & control*; D012307:Risk Factors; D012535:Scalp / Q000473:pathology*; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents