MRI Test Identifies Candidates for Lower-Dose Radiotherapy in HPV Throat Cancer

Its incidence is rising, and many patients receive high-dose radiotherapy that can cause long-term swallowing problems, dry mouth, taste changes, and fatigue. To help address this challenge, researchers have now developed an MRI-based test that identifies tumors potentially suitable for lower-intensity treatment.

The technique, called HYPOXiMAP, is being developed by The Institute of Cancer Research, London (ICR), with University College London and The University of Manchester. It uses advanced MRI to detect hypoxia, which refers to low-oxygen areas inside tumors. These oxygen-starved regions are clinically important because they are associated with greater resistance to radiotherapy.

HYPOXiMAP displays tumor oxygenation as an intuitive color map. Blue areas indicate hypoxic, treatment-resistant tissue, while yellow areas show well-oxygenated regions that typically respond well to radiotherapy. The approach is intended to help clinicians identify patients with HPV-positive throat cancer who may receive reduced radiotherapy doses while maintaining treatment benefit.

There are around 13,000 new cases of head and neck cancer in the U.K. each year. HPV-positive throat cancer cases rose by 47% between 2013 and 2019. Around 70% of patients are treated with radiotherapy, and more than half experience significant long-term side effects.

Earlier U.S. studies have shown that specialized positron emission tomography (PET) scans can identify well-oxygenated tumors suitable for radiotherapy dose reduction. However, these scans are costly and available only in limited research centers in the U.K. Because MRI scanners are standard equipment across National Health Service hospitals, HYPOXiMAP is being developed as a more accessible alternative.

The research team has shown that the MRI-based method can reliably distinguish oxygen-rich from oxygen-poor HPV-positive throat cancers. It can also monitor changes in tumor hypoxia during radiotherapy, providing real-time feedback on treatment progression. A four-year program will refine the imaging process using artificial intelligence to improve the speed, accuracy, and consistency of tumor oxygenation measurements.

The program includes a prospective, multicenter study managed by the ICR Clinical Trials and Statistics Unit. This study will test how consistently HYPOXiMAP performs across hospitals and MRI scanners. Future oxygen-enhanced imaging could also help identify patients who may benefit from immune checkpoint inhibitor drugs, which are less effective in hypoxic tumors.

“HYPOXiMAP represents the culmination of 15 years of work to turn MRI into a tool that can show us exactly where low-oxygen, treatment-resistant cancer cells are located. This technology has the potential to transform how we tailor radiotherapy for patients. For those with HPV-positive throat cancer and well-oxygenated tumors, this technique could help us safely reduce treatment intensity—protecting quality of life without sacrificing cure rates. This new funding allows us to take the final steps to bring this technology into clinical trials and, ultimately, into the hands of clinicians across the NHS,” said Professor James O'Connor, professor of quantitative biomedical imaging at The Institute of Cancer Research, London, and professor of radiology at The University of Manchester.

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The Institute of Cancer Research
University College London 
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