Radio-chemotherapy with cisplatin


Cisplatin  (PtCl2(NH3)2)

In the early 80's, Harry Bartelink works for some time at Stanford University in Palo Alto (USA). He studies the effectiveness of radiotherapy when chemotherapy is given simultaneously. Up to that time it is common practice to give chemotherapy first with radiotherapy afterwards.  The combination with cisplatin seems to work best when it is combined with simultaneous radiotherapy. In the Netherlands Cancer Institute (NKI) this combination treatment is given with success in the treatment of lung tumours. In the years to follow, the combined treatment with cisplatin is used increasingly in many clinics in the world. After lung cancer, the combination therapy with cisplatin is developed for other tumours.

Cisplatina, (PtC12(NH3)2) is a cytostatic drug, used in the treatment of cancer. It slows down the synthesis of DNA in the cell by laying cross links between the DNA strands. The drug is also known under the name cisplatin (from the  medical point of view) or cisplatina (more the from the chemical view). It is used alone or in combination with other cytostatic drugs, cell growth retardants used as first line medicine to treat among other things metastasized ovarian carcinoma. 

Cisplatin causes many side-effects, such as severe kidney toxicity, bone marrow suppression, deafness and nausea. In many cases, with regard to the latter, the drug is better tolerated if given with anti-nausea medication.

More information on Cisplatin in Wikipedia [65]:

Caro Koning in AMC.JPG 

Radiation Oncologists Dr. Caro Koning

Results of the combination treatment in the Netherlands Cancer Institute:         Many years of research by the radiobiology group and the physicians in the NKI, in the area of interaction between cisplatin and radiotherapy, have resulted in both improved local control and survival in patients with inoperable lung cancer. This has been shown by the results of an international trial of the EORTC which was led by Dr. Harry Bartelink and Dr. Caro Koning.

In October 1991, Dr. Caro Koning obtained her doctorate from the University of Amsterdam [66] with a thesis on this subject.  The success of the combination treatment in the Department of Radiotherapy in the NKI was crowned by the appointment of Dr. Harry Bartelink as extra-ordinary professor at the Free University of Amsterdam.

In 1992, the results of the new combination treatment are published in the New England Journal of Medicine (USA).  In spite of the success, Bartelink doubts the suitability of cisplatin. During the coming years, he concentrates on the breast-sparing combined surgery and radiotherapy. 

Other researchers in Europe and the US continued experimenting with combined chemo-radiotherapy and succeed in designing an effective treatment for various tumours. Radiobiologist Dr. Adrian Begg, of the Department of Experimental Therapy in the NKI, showed that the effectiveness of the combined therapy could be increased by adapting the clinical treatment schedule to the characteristics of the tumour.  In 1996, a feasibility study was successfully completed (together with the Department of Radiotherapy of the University Medical Centre, Amsterdam (AMC) into the combination of daily treatment with cisplatin and a more intensive radiotherapy schedule. This is an example of joint clinical and biological research which was continued into a large randomized EORTC study. 

In 1998 this development was continued with a new promising treatment of cancer in the head and neck area.  This so-called Rad-Plat (radiotherapy and platinum) treatment was developed by Professor K.T. Robbins of Memphis (USA). In particular, patients with large tumours of the head and neck benefit from this.  Every year around 2400 Dutch patients, mainly men, develop cancer in the head/neck region. A quarter of them present with a large tumour.  The head and neck region is a difficult area to operate on and surgery can have serious consequences for speech and swallowing and cvan cause facial mutilation, in spite of all modern techniques. Moreover, these tumours often return even after surgery and radiation.  The NKI is the first European clinic to study the possible reduction of the need for mutilating operations by a treatment with irradiation in combination with local, via arterial delivery of high dose chemotherapy (cisplatin).

For further developments, see the item "The state of concurrent chemo-radiation" in 2007



Bronnen & Publicaties

  • [65] ,
  • [66] “Radiotherapy and Cisplatin: A Perspective” Doctoral thesis by Caro Schaake-Koning, Vrije Universiteit, Amsterdam 1991. Supervisor prof. dr G. M. M. Bartelink. ,