van de Sande Mariska A E, van den Hurk Corina J G, Breed Wim P M, Nortier J W R Hans
Leids Universitair Medisch Centrum, afd. Klinische Oncologie, the Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A2134.
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.
Observational study.
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).
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.
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.
调查高危乳腺癌患者头皮转移的发生率，以评估在辅助治疗期间进行头皮冷却是否有必要谨慎操作。
观察性研究。
对885例评估良好的高危乳腺癌患者的头皮转移发生率和病程进行研究。这些患者至少有4个腋窝淋巴结阳性，在一项随机研究中接受经典化疗，或相同化疗后进行大剂量化疗和自体干细胞移植（即所谓的N4+研究）。
中位随访110个月后，885例患者中有403例（46%）复发或发生转移。25例患者（3%）发生皮肤转移；其中4例患者（0.5%）发生头皮毛发转移。头皮转移总是与其他部位的转移同时或之后发生。
头皮转移发生率极低，并非转移性疾病的首发症状。因此，头皮冷却（以防止脱发）不太可能降低化疗的局部疗效，以至于增加头皮转移的风险。
