Comparative efficacy of interventions for preventing chemotherapy-induced alopecia: a systematic review and network meta-analysis

Chemotherapy-induced alopecia (CIA) negatively affects patients' appearance and emotional well-being. This network meta-analysis aimed to compare the efficacy of different preventive interventions for CIA.

We searched PubMed, Embase, CENTRAL, and EBSCO Open Dissertations from inception to March 2025. Randomized controlled trials evaluating interventions to prevent CIA in cancer patients and reporting hair preservation outcomes (as defined by individual trials, including CTCAE grade < 2, < 30 to < 50% hair loss, or WHO grade 0-2) were included. Scalp hypothermia was divided into three groups based on duration post-chemotherapy: short (0-45 min), traditional (46-90 min), and prolonged (> 90 min). Risk of bias was assessed using Cochrane RoB2. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Interventions were ranked with surface under the cumulative ranking curve (SUCRA), and certainty of evidence was evaluated using CINeMA.