What is it about?
Radiation-induced alopecia is one of the most visible side effects of cranial and head-and-neck radiotherapy. While it’s often considered a minor toxicity, for many patients it has a significant psychosocial impact and affecting self-image and quality of life. Despite this, clinicians still lack clear dose thresholds and practical planning guidance to distinguish between temporary and permanent alopecia. That gap is what motivated this review.
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Why is it important?
In Key findings section, several consistent patterns emerged. First, radiation-induced alopecia is clearly dose-dependent. In fact, Temporary alopecia typically occurred at mean scalp doses around 20 Gy and Permanent alopecia became likely when mean scalp dose exceeded 30 to 36 Gy Second, we found that near-maximum scalp dose, rather than mean dose alone, is a critical predictor. Metrics such as D2% and high-dose scalp volumes consistently correlated with alopecia severity Severe, grade-2 permanent alopecia had an estimated D50 of approximately 44 Gy, particularly driven by small high-dose hotspots It must be mentioned that, the findings held true across both photon and proton cohorts.
Perspectives
We also identified major gaps: First, Significant heterogeneity in scalp contouring and alopecia classification Second, Limited use of patient-reported outcomes, despite clear psychosocial burden Third, Future work should focus on standardization, prospective validation of predictive models, and better integration of quality-of-life measures into clinical trials.
Dr. Pouya Saraei
Shiraz University of Medical Sciences
Read the Original
This page is a summary of: Radiation-Induced Alopecia in Patients Undergoing Intracranial Radiotherapy: A Systematic Review, International Journal of Radiation Oncology*Biology*Physics, February 2026, Elsevier,
DOI: 10.1016/j.ijrobp.2026.01.042.
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