Scalp Segmentation and Permanent Alopecia Prediction in Pediatric Craniospinal Irradiation: The PAST and HOPE Projects

    June 2026 in “ EJC Paediatric Oncology ”
    Camilla Satragno, Gianluca Piccolo, Federica Picichè, Mattia Barboro, Irene Schiavetti, Sucheeta Campora, A. Alparone, Stefania Zara, Daniele Zefiro, F. Cavagnetto, Marta Molteni, Claudia Mercuri, Flavio Giannelli, Claudia Milanaccio, Salvina Barra, Antonio Verrico, Liliana Belgioia
    The study focused on predicting permanent radiation-induced alopecia (RIA) in pediatric patients undergoing craniospinal irradiation (CSI) using the Pediatric Atlas-Based Scalp Segmentation Technique (PAST) and the Hair loss Outcome Prediction and Evaluation (HOPE) projects. Involving 48 pediatric patients, the study developed an atlas-based automated contouring protocol, achieving significant time efficiency and accuracy in scalp segmentation. Permanent RIA was observed in 45.8% of patients, with high-dose thiotepa and twice-daily fractionation identified as significant predictors. Dosimetric thresholds were established to aid in scalp-sparing CSI planning, highlighting the importance of radiation dose and treatment intensity in RIA development.
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