Dysphagia-optimised intensity-modulated radiotherapy versus standard radiotherapy in patients with pharyngeal cancer

We studied with keen interest the results of the phase 3 DARS trial by Christopher Nutting and colleagues and congratulate the authors for their hard work in this landmark trial. 1 Nutting C Finneran L Roe J et al. Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial. Lancet Oncol. 2023; 24: 868-880 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar The authors compared the effects of dysphagia-optimised intensity-modulated radiotherapy (DO-IMRT) with standard-intensity modulated radiotherapy (S-IMRT) on swallowing outcomes of patients with pharyngeal cancer and noted a significantly higher mean MD Anderson Dysphagia Inventory (MDADI) composite score at 12 months in favour of DO-IMRT. It was also reassuring to know that there was no significant difference between the groups in the incidence of locoregional recurrence or the time to recurrence. Dysphagia-optimised intensity-modulated radiotherapy versus standard radiotherapy in patients with pharyngeal cancerChristopher Nutting and colleagues recently reported the results of a randomised trial comparing dysphagia-optimised intensity-modulated radiotherapy (DO-IMRT) with standard IMRT in patients undergoing radiation treatment for head and neck cancer.1 Some forms of DO-IMRT, which involve actively reducing the radiation dose received by the pharyngeal constrictor muscles, have been considered standard in many institutions and collaborative trials groups for some time now, and the authors should be congratulated on providing level 1 evidence for this practice. Full-Text PDF Dysphagia-optimised intensity-modulated radiotherapy versus standard radiotherapy in patients with pharyngeal cancer – Authors' replyWe thank the readers for their kind comments on our work. Ahitagni Biswas and colleagues rightly point out that over 80% of patients in the DARS trial had human papilloma-virus (HPV) positive oropharyngeal cancer.1 In India, less than a quarter of patients present with this type of cancer and most patients have more locally advanced disease. They therefore question whether the results of DARS can be reproduced in community practice in India. Full-Text PDF