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Alopecia during chemotherapy is a distressing side effect of chemotherapy and affects a patient's quality of life. A systematic review and meta-analysis of randomized controlled trials comparing scalp cooling with no scalp cooling using Cochrane methodology was undertaken. Meta-analysis of scalp cooling studies showed a significant reduction in alopecia. Scalp cooling should be presented as an option to patients.Alopecia is a side effect of chemotherapy and affects a patient's quality of life. Cooling the scalp during chemotherapy might reduce alopecia. The objective of this systematic and meta-analysis was to examine the effects of scalp cooling on the end point of alopecia in randomized controlled trials.Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Electronic searches of databases were undertaken through February 2017. In addition other sources were searched. All languages were considered for evaluation. Data were collected and evaluated using a data collection form. Assessment of biases was undertaken using Cochrane methods. When studies could be combined, binary outcomes were evaluated using risk ratio assessment and continuous outcomes were assessed using mean difference (MD). Confidence intervals (CIs) were included and heterogeneity using the I2 statistic. Grading of Recommendations, Assessment, Development, and Evaluation assessments were also made.Ten studies were included in the analysis comprised of 654 patients. Most were patients with breast cancer 432 patients [66%] mainly receiving anthracyclines. For the binary outcome of < 50% versus > 50% alopecia, the use of scalp cooling reduced relative risk (RR) of alopecia by 43% (RR, 0.57; 95% CI, 0.45-0.72; I2 = 11%; P < .00001). For ordinal outcomes (alopecia on a scale of 0-3), use of scalp cooling significantly reduced alopecia (MD, −0.80; 95% CI, −1.19 to −0.41; I2 = 0%; P < .0001). The quality of the evidence was graded as moderate.This systematic review and meta-analysis supports the use of scalp cooling to prevent alopecia in patients with solid tumors undergoing chemotherapy.