Concomitant Intra-arterial Cisplatin Infusion with Radiation Therapy (RADPLAT) for Laryngeal Cancer: Technical and Practical Consideration

Abstract

RADPLAT is intensive targeted chemoradiation consisting of superselective intra-arterial cisplatin infusion concurrently with radiotherapy for advanced head and neck cancer. It was proposed by Dr.Robbins in 1992. In RADPLAT, surgery is performed only for salvage purpose.
Larynx preserving treatment has a social impact. Larynx preserving treatment avoiding radical laryngectomy is thought to be an ultimate frontier of RADPLAT. The main feeding artery of laryngeal carcinoma is the superior laryngeal artery, which is a branch of the superior thyroid artery. Most of the larynx is supplied by superior laryngeal artery, but some parts of the larynx are supplied by small arteries from glandular branches of the superior thyroid artery, penetrating through the thyroid cartilage. Generally speaking, super-selective infusion into the feeding artery is ideal. However, high dose cisplatin infusion into superior laryngeal artery may induce complications of laryngeal mucosal necrosis, laryngeal edema or nerve palsy. We should consider the larynx to be a more delicate organ than the maxillary or tongue. We infuse cisplatin at the point of the bifurcation of the superior laryngeal artery. Super-selective infusion of cisplatin into the superior laryngeal artery has risks of complications such as mucosal necrosis, laryngeal edema or laryngeal nerve palsy. We would emphasize that less frequent and milder adverse events were experienced in our series, unlike concurrent systemic chemoradiation therapy.