Radiotherapy in combination with simultaneous intra-arterial chemotherapy (RADPLAT) in patients with advanced head and neck cancer

Abstract

A particular challenge for both laryngologists and oncologists is presented by the fact that treatment of patients in advanced stages of cancer disease, in whom either combined therapy (surgery and adjuvant radiotherapy) or radiotherapy alone have been applied, is associated with highly dissatisfying results. Clinical trials exploring the application of chemotherapy combined with simultaneous radiotherapy are arousing greater interest. This is because the results of recently published randomised prospective studies and meta analyses show improved loco-regional results of this treatment strategy, which in turn improves overall survival. Cytostatic drugs used in conjunction with radiotherapy have many functions but, above all, their purpose is to intensify the effects of irradiation which, in such treatment schemes, is the leading method. One of the basic factors limiting the application of such strategies is the problem of how to limit the toxicity from one side, while administering a sufficiently high dose of cytostatics, and to continue without any gaps the course of radiation from the other. A problem associated with combined therapy is how to ensure the highest concentration of cytostatics is in the malignant tumour. The need to break through both of these limiting factors has become the subject of intensive research. One of the possible solutions to these problems is the simultaneous application of irradiation in combination with selective intra-arterial chemotherapy. To date, final results are still unavailable from phase III clinical trials which are investigating this treatment method. Presented in this paper are the advantages and disadvantages in the treatment strategy called the RADPLAT programme. The RADPLAT programme is characterised by great local effects, somewhat lesser regional effects and still lesser effects in the treatment of micro-metastases. Research is continuing, in order to find methods for the improvement of treatment results, with a view to reducing the risks of distant metastases and/or regional treatment failures.