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Background: Chemotherapy (Ctx)-induced alopecia (CIA) produces a deep psychological impact in many women involved. Although approved by the FDA due both its effectiveness and safety to prevent CIA, sensor-controlled scalp cooling (SCSC) is still infrequently used in many countries due to physiciansu00b4 concerns regarding both its safety and feasibility, in particular regarding anthracycline based-Ctx. This retrospective analysis was initiated to obtain more detailed information about the effectiveness and safety of SCSC using the Paxman system (Paxman, Huddersfield, UK) in a routine population of in patients (pts) with primary (PBC) or recurrent/metastatic breast cancer (RMBC) exposed to CIA-inducing neoadjuvant (NACT), adjuvant Ctx (ACT), or palliative Ctx (PCT).Methods: 109 pts who underwent SCSC from 2014-2017 were identified from our database: NACT, 47 (43.1%); ACT, 40 (36.7%); PCT 22 (20.2%); dose-dense (dd) Ctx, 44 (40.4%); non-dd Ctx 65 (59.6%); premenopausal, 53 (48.6%); postmenopausal, 56 (51.4%). The following Ctx regimens were used: A+T/Au2192T, 41 (37.6%), Tu2192A, 23 (21.1%), T, 34 (31.2%), non-A/non-T, 11 (10.1%). Pts were subjected to SCSC during each Ctx cycle. CIA was quantified according to the Dean score (DS) determined 3 wks after the last Ctx cycle. Data were analyzed regarding feasibility indicated by the SCSC completion rate, quality of hair preservation (success: DS 0-2, failure: DS 3-4), reasons of SCSC discontinuation, and safety. Moreover, the following parameters were investigated in regard to the success of SCSC: menopausal status, NACT vs ACT, dd Ctx vs non-dd Ctx, Ctx regimen.Results: The success rate was 67.9% with 47 pts (43.1%) experiencing complete hair preservation (DS 0), and 27 (24.8%) showing partial response to SCSC (DS 1-2). 30 pts (27.5%) stopped SCSC prematurely with CIA being the reason in 26 pts (23.9%) and side effects in 9 pts (8.3%). Side effects were all not severe and resolved quickly after cessation of SCSC. Effectiveness of SCSC did not differ for most analyzed subgroups. The relative risk (RR) to experience CIA was 1.18 (CI: 0.91-1.53) for post- vs premenopausal pts, 1.27 (CI: 0.99-1.64) for Ctx-nau00efve vs pretreated pts, 1.18 (CI: 0.89-1.56), and 1.42 (1.11-1.85, 0.0118) for A-based Ctx vs non A-based Ctx. Success rates for A+T/Au2192T, Tu2192A, T, and non-A/non-T were 48.8%, 73.9%, 79.4%, and 90.9% (p=0.0149).Conclusions: SCSC was feasible, safe and effective in order to prevent CIA in a real-world population of pts with PBC. All therapeutic subgroups benefited from SCSC. A-based Ctx per se is clearly not a contraindication for SCSC. However, the success rates are significantly higher when Ctx does not start with the anthracycline.