Definitive alopecia

[Kroll2013]

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Beyond what skin dose we have an increased risk of definitive alopecia?

 

[medgator]

Whole brain dose, it comes back eventually months down the road in most people.

Gbm dose, probably not coming back in the high dose/boost area

 

[Palex80]

In my opinion a dose of 50 Gy and more can cause definitive alopecia.
I have a couple of patients with G2 astrocytoma and meningeoma, who have focal definitive alopecia now 3 years after treatment.

Interestingly, since we have been treating with IMRT/VMAT, I am seeing less patients with alopecia.

 

[Cancerdancer]

Agree, without checking my physics, I'm guessing dose to hair follicles (? 5 mm deep from skin surface) is maybe what, 40-50% Dmax dose with 6 MVs in the buildup range. With 30 Gy whole brain you're talking ~12-15 Gy to the follicles, seems to grow back. With 60 Gy you're at 24-30 Gy, tends not to grow back. I've seen some scalp low-grade cutaneous lymphomas treated with electrons in the 24-30 Gy with permanent alopecia, seems to roughly fit.

 

[seper]

In tangential portion of beams, dose to follicles is much higher than your guess. Hence "reverse mohawk".