RADPLAT: An Alternative to Surgery?

Abstract

Head and neck cancer frequently presents at a late stage, leading to a poor prognosis despite optimal treatment with surgery and/or radiotherapy. Chemotherapy for advanced disease has shown little benefit as a single-modality treatment, and the use of concurrent chemoradiation is limited by problems with severe toxicity at higher doses. RADPLAT is the acronym used to describe a new technique, combining intra-arterial delivery of cisplatin with systemic neutralization by i.v. sodium thiosulphate, and concurrent radiotherapy. This allows very high cisplatin dose intensities to be used while potentially minimizing adverse systemic effects. Initial results suggest that excellent locoregional control rates are achievable in patients with unresectable disease, with a favorable side-effect profile when compared with conventional chemoradiation protocols. In addition, RADPLAT may potentially be of benefit in selected patients with resectable disease, allowing for preservation of organ function and quality of life without compromising locoregional control or survival. While current phase II data are encouraging, phase III randomized controlled trials are required in order to directly compare RADPLAT with i.v. chemoradiation therapy, the current standard of care. This article reviews the evolution of the RADPLAT concept, from initial clinical trials to its current application in the treatment of patients with advanced head and neck cancer.

Intra-arterial chemoradiotherapy for locally advanced oral cavity cancer: analysis of therapeutic results in134 cases

“…Currently, there are two procedures for performing arterial infusion therapy for head and neck cancer: namely, a procedure in which a catheter is inserted into the target artery through the superficial temporal artery, as presented in this study, and a procedure in which a catheter is inserted into the target artery through the femoral artery by Seldginger's procedure (Robbins et al, 1994(Robbins et al, , 2000Balm et al, 2004;Alkureishi et al, 2006). The latter procedure is simpler than the former procedure, and it facilitates the administration of anticancer agents into several arteries; however, drug administration over a long duration is impossible, and catheter operation-related cranial nerve disorders may sometimes occur.…”

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

“…However, organ-sparing treatments often fail to preserve function [10][11][12][13][14][15]. Acute toxicities, or side effects that occur during (and up to 3 months after) radiotherapy or chemoradiotherapy, are common and may include mucositis, xerostomia, odynophagia, and dysphagia [9,[16][17][18][19][20][21][22].…”

Valid and reliable techniques for measuring fibrosis in patients with head and neck cancer postradiotherapy: A systematic review

“…With the advent of radiotherapy techniques and chemotherapy agents, however, “organ‐sparing” treatments, which, in many cases, utilize multiple modalities, have become more common . Although these “organ‐sparing” interventions have preserved tissue without compromising survival and disease control, they have not reliably preserved organ function . Radiation and chemotherapy‐related toxicities frequently occur and are sometimes chronic in nature …”