28th Nov 2023

New gold standard in radiotherapy

I am pleased to report a pioneering new gold standard in the treatment of patients with head and neck cancer.

This is a new radiotherapy technique developed at The Royal Marsden and The Institute of Cancer Research (ICR) that can significantly reduce swallowing problems for patients.

Difficulty in swallowing (or dysphagia) is a major side-effect of radiotherapy for throat cancer, leaving some patients having to rely on a feeding tube.

Some years ago, I was at the forefront of developing Intensity-Modulated Radiotherapy (IMRT), a precision form of radiotherapy that aims to avoid healthy tissue around the cancer site.

Working with colleagues at the Royal Marsden and the ICR, we have now further refined this technique to reduce the damage to healthy organs even more.

The new technique is called dysphagia-optimised IMRT (DO-IMRT), and it is being hailed as a “game-changer” and the new gold standard in targeted radiotherapy.


DO-IMRT uses a computer programme to divide the radiation into lots of smaller teams that can be more precisely targeted at the cancer and then switched off.

Around 12,400 people are diagnosed each year with head and neck cancer in the UK. It is the 8th most common cancer, accounting for 3 per cent of all new cancer cases, according to Cancer Research UK.

Around 70 per cent of people who are cured of this type of cancer are left with life-changing swallowing issues.

The development of DO-IMRT follows a two-year Dysphagia-Aspiration Related Structures (DARS) trial, funded by Cancer Research UK with support from The National Institute for Health and Care Research and The Royal Marsden Cancer Charity.

Results of the study showed that double the number of patients treated with DO-IMRT (40%) reported being able to swallow as well as ever compared with those treated with standard IMRT (20%) two years following treatment.

Patients who received DO-IMRT had also previously reported better swallowing function at 12 months compared those who received standard IMRT.

Of those treated with DO-IMRT, over four in five (81%) reported high normalcy of diet – meaning they were still able to eat at least some foods that require chewing.

And over nine in 10 (92%) said they felt comfortable eating in public, compared with just under 73% and 85% of those treated with standard IMRT respectively.

The study included 112 newly diagnosed patients with oropharyngeal and hypopharyngeal cancers (tumours of the throat) from centres across the UK and Ireland. Half received standard IMRT and half received DO-IMRT every day for six weeks.

Patients have hailed the treatment as life-changing, while NHS officials hope it will also create savings as patients will not have to be treated for swallowing issues for the rest of their lives.

My view is that the findings indicate a new gold standard for treating head and neck cancer patients with radiotherapy has been set. We have demonstrated that DO-IMRT can spare the swallowing muscles of patients without impacting the success of their treatment.


What’s more, this new technique is achievable for all centres currently offering IMRT.

It simply requires some additional time from the radiation oncologist and physicist to make adjustments to help reduce the irradiation of the muscles that control swallowing. Next, we’re planning to teach others around the world how to reproduce this new treatment approach.


Professor Emma Hall, Deputy Director of the Clinical Trials and Statistics Unit at the ICR said: “Radiation is a vital treatment for patients with head and neck cancer but it can damage important muscles involved in swallowing and talking.

“This cutting-edge radiotherapy technique delivers more precise radiotherapy – targeting cancer cells while sparing these important structures. I am very pleased that the latest results of the DARS trial show the potential of DO-IMRT to reduce side effects from radiotherapy and improve patient’s lives.”

Dr Justin Roe, Consultant SLT and Joint Head of the Department of Speech, Voice and Swallowing at The Royal Marsden NHS Foundation Trust, said: 

“Eating and drinking are not only key for survival but are also two of the most fundamental pleasures in our lives and are often central to the way we socialise. However, despite advances in recent years, radiotherapy can be devastating for patients with head and neck cancer, and, in most cases, swallowing is affected.

“The treatment sometimes leaves people unable to eat and drink safely or comfortably. This can cause enormous distress during mealtimes. Patients may also avoid social situations involving food and drink too, leading to isolation. It can also have a significant impact on hydration, nutrition and in the most severe cases, can lead to significant respiratory complications. I’m delighted the DARS trial has discovered a new kinder way to treat this patient group, offering many a significantly improved chance of getting back to a more normal life.”

For more information about Prof Nutting's work please visit the CV page, get in touch or arrange a consultation.