Advice on hair and scalp care during cranial radiotherapy: a prospective randomized trial

Background: The advice on hair washing during brain irradiation is aimed at minimizing radiation induced skin toxicity. We performed a prospective ran domized trial to assess the effect of advice on scalp care on the local ski n reaction in patients undergoing cranial radiotherapy. Methods: One hundred and nine patients undergoing cranial radiotherapy were randomized into two groups. Patients in group 1 were advised not to wash h air during treatment and patients in group 2 to maintain normal pattern of hair washing. They were assessed weekly over a period of 10 weeks from the start of treatment. Symptoms of pain and itching were recorded using a modi fied RTOG/EORTC acute skin reaction scoring system and skin reaction was as sessed clinically using erythema/desquamation score. The frequency of hair washing and the distress of changing the practice of normal hygiene were re corded on a diary card. Skin reaction scores were compared as a summary mea sure using area under the curve per week (AUC/week) and median scores, and the differences between groups were assessed by means of the t-test. Results: One hundred and nine patients commencing cranial radiotherapy acco rding to standard protocol were randomized into the trial (group 1, 55 pati ents; group 2, 54 patients). Patients asked to restrict hair washing, washe d at a lower average frequency. There were no significant differences betwe en scores of skin reaction in the two groups for each of the variables meas ured. Conclusions: The practice of normal hair washing is not associated with inc reased severity of adverse skin reaction. As a request to change the patter n of normal hygiene may cause distress, the current advice should be to mai ntain normal hair washing during cranial radiotherapy. (C) 2000 Elsevier Sc ience Ireland Ltd. All rights reserved.