Abstract
Alopecia is a distressing side-effect of cancer treatment. Taxanes (TX) anthracyclines (ANR) and etoposide (ET) have been consistently associated with significant alopecia. We studied an effective scalp cooling system, The Penguin Cold Cap System, for the prevention of chemotherapy-induced alopecia in 70 patients receiving chemotherapy, including one of the following major alopecia-causing agents: Group A, TX based regimes (without ANR): Group B, TX + ANR: Group C, ANR-based regimes (without TX): Group D, ET-based regimes. Protection from hair loss was achieved by maintaining scalp temperatures below 15°C before, during and after chemotherapy by frequent changing of the caps. Assessment was carried out using a grading system from 0 to 4. Grades 0-2 were considered as satisfactory hair protection, whilst grades 3-4 were considered failures. 57 patients were evaluable for assessment. An overall 81% protection was achieved. In groups C and D 11 of 12 patients (92%) had no alopecia, whilst 30 of 34 patients (88%) treated with taxanes had adequate hair protection. In Group B, 4 of 11 patients (36%) had adequate hair protection. The system was well tolerated and is a very effective method for protection from hair loss caused by TX, ANR and ET. Our results are comparable with and, in most cases, better than those reported in other studies using various alopecia preventive methods.


Conclusion
We conclude that the Penguin Cold Cap System is a very effective and well-tolerated method of protection from chemotherapy-induced alopecia. It offers protection to most patients treated with agents which would otherwise cause significant hair loss. Further studies are required to clarify the mechanism of alopecia in the anthracycline-taxane combination and to develop methods of overcoming it (See note below).

Acknowledgements
The authors wish to express their gratitude to Medical Specialties of California UK for providing the Penguin Cold Caps used in this study and MSC Hellas A.E. who sponsored this study and the cold therapy nurses Maria Kravariti and Photini Masoura for their significant contribution to the success of cold therapy.

NOTE: Since this publication MSC has studied and developed a new cold therapy protocol for use with the anthracycline-taxane combination which has greatly increased the success rates.