Low-Dose Radiation Successfully Treats HPV Throat Cancer With Fewer Side Effects

 

This story was originally published in 2017 and was last updated in May 2026.

After a decade of research seeking ways to make radiation treatment easier for patients, doctors at Memorial Sloan Kettering Cancer Center (MSK) have confirmed that many HPV-positive throat cancer patients can be treated with significantly less radiation — and still survive the disease.  

A new analysis of multiple studies conducted over 10 years shows that carefully selected patients can receive a substantially reduced radiation dose that keeps the cancer away while dramatically cutting down on the debilitating side effects that often make eating and swallowing difficult. 

The data found that 97% of patients receiving the reduced treatment were alive after five years. MSK radiation oncologist Nancy Lee, MD, is presenting the findings at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting. This conclusion, based on massive amounts of data, is a critical step toward obtaining approval from the U.S. Food and Drug Administration (FDA).

“This has been an absolute game changer for treating certain people with throat cancers caused by the human papillomavirus or HPV,” says Dr. Lee, who pioneered the approach. “The difference in toxicity is dramatic.” 

The method involves giving reduced doses of radiation to certain patients after their tumors have been surgically removed. Some people may even be able to skip surgery altogether while still receiving the lower dose. Dr. Lee has led multiple studies at MSK showing that this approach can effectively control the cancer while dramatically improving patients’ quality of life. She says this lower-dose treatment can be extended to other types of HPV-positive head and neck cancers. 

The need for a treatment that works while minimizing toxicity is urgent. Approximately 16,000 people are diagnosed with throat cancers thought to be caused by HPV in the United States every year, according to the Centers for Disease Control and Prevention (CDC). Cases have been surging in recent years, especially among men.

Reducing radiation by more than half

Radiation dosage is measured in units called Gray (Gy). The standard dosage for throat cancer has long been 70 Gy, along with three cycles of chemotherapy. 

While this approach achieves high survival rates, it takes a major toll on patients. They often experience mouth sores, difficulty swallowing, dry mouth, changes in taste, and nausea. Weight loss of 20 to 30 pounds is common, and many patients cannot work for months during and after treatment. 

In recent years, pioneering work by Dr. Lee has shown that many HPV-positive head and neck tumors can be safely treated with a 30-Gy dose and two cycles of chemotherapy. 

The analysis looked at data from 430 patients with HPV-positive throat cancer. By using a specialized imaging technique measuring the amount of oxygen in a tumor, researchers could determine which patients would respond well to the reduced treatment. Tumors with low oxygen levels (hypoxic tumors) are less likely to respond to just 30 Gy and two rounds of chemotherapy.

• Of the patients enrolled in the various trials, 75% were eligible for the reduced treatment. The other 25% received the standard, higher-dose treatment.
• Both patient groups had a five-year overall survival rate of 97% — meaning the reduced radiation and chemotherapy treatment controlled the HPV positive throat cancers as well as the standard dose.
• The five-year progression-free survival rates (the length of time before the cancer begins growing again) were similar: 90% for the low-dose group and 89% for the standard-dose group.

“We are challenging the traditional dogma of using a one-size-fits-all approach to treat cancer and changing it to a more personalized treatment,” Dr. Lee says. 

Dr. Lee is Vice Chair of the Department of Radiation Oncology, Service Chief of Head and Neck Radiation Oncology, and Service Chief of Proton Therapy at MSK.

FMISO PET scans identify patients eligible for low-dose radiation

The success of the reduced-intensity treatment hinges on precise patient selection. While researchers have long sought ways to identify HPV-positive patients who could safely receive less-intensive treatment, traditional factors, such as smoking history, were not reliable.

Dr. Lee and colleagues pioneered a novel approach: selecting patients based on oxygen levels in their tumors. This distinction is critical because hypoxic tumors are more resistant to radiation and chemotherapy, making them poor candidates for dose reduction. 

 

 

Fortunately, most head and neck cancers, including throat cancers, are nonhypoxic, which means they have normal levels of oxygen. Patients with these types of cancers are eligible for the reduced treatment. 

A specialized imaging technique called FMISO PET can reveal whether a tumor is hypoxic.

“Dr. Lee has really pioneered using hypoxia imaging to pick out tumors that are more sensitive for this deescalated regimen,” MSK radiation oncologist Nadeem Riaz, MD, MSc, says. 

Building the evidence

“These results from a much larger patient group further validates that FMISO PET can reliably identify hypoxic tumors and guide doctors in selecting the right patients to receive reduced radiation,” Dr. Lee says. “We now have even more solid evidence supporting this approach, and we’re optimistic it will soon become the standard of care for many HPV-positive cancer patients.”

Expanding access by standardizing image interpretation 

MSK researchers are investigating how the FMISO PET approach can become more widely available. While MSK’s nuclear medicine physicians are highly trained in interpreting FMISO PET images, there have been no standardized criteria to guide physicians with less experience. The absence of standardized interpretation has been a significant obstacle — one that has hindered FDA approval for widespread use FMISO PET scans.

Developing universal training

To address this barrier, nuclear medicine physicians Heiko Schöder, MD, and Rick Wray, MD, developed a training program so physicians at all levels of experience can accurately evaluate the hypoxic status of the tumor. In 2024, they reported results in the Journal of Nuclear Medicine, validating that the standardized method worked well for nuclear medicine physicians with different levels of expertise. 

“Doctors have to be confident the right patients are being selected for the low-dose approach,” Dr. Wray says. “A standardized way of interpreting the images makes it possible for this method to be used almost anywhere FMISO PET is available.”

An alternative for patients ineligible for low-dose radiation treatment

Not all people with HPV-positive cancers are eligible for the 30 Gy protocol. Those with larger tumors or who lack access to specialized imaging and frequent monitoring require a different strategy.

For these patients, MSK developed a slightly different plan that’s more accessible to people living far from major cancer centers:

• Give a lower dose over three weeks to the visible tumor and surrounding tissue to kill any stray cancer cells. 
• Deliver additional doses using highly precise techniques only to the visible tumor. The tumor still receives a total of 70 Gy — the standard-dose protocol — but the surrounding healthy tissue is spared radiation, thereby reducing side effects.

 Dr. Lee and other MSK colleagues published results validating this hybrid technique in JAMA Oncology in 2022, demonstrating its potential to be used for more patients

The research continues with an ambitious goal: making 80% to 85% of people diagnosed with HPV-related head and neck cancers eligible for lower-dose therapy.

“In addition to dramatic improvement to patients’ quality of life, we’re saving them the hassle of having to come in every day,” Dr. Lee says. “They can get back to doing the things they love.”

MSK’s history of improving quality of life for patients

Dr. Lee first recognized an opportunity for the low-dose approach more than 10 years ago based on earlier research she had read showing that the method worked for HPV-positive anal cancers. It raised the question: Could certain HPV-related head and neck cancers be treated with a similar dose reduction? 

The results have been transformative: Patients had less throat pain, less fatigue, and fewer radiation burns.

“It’s really hard to describe the huge difference this makes,” Dr. Riaz says. “Using the smaller dose over just three weeks, they have almost no radiation side effects.”

Decreasing chemotherapy also eases the burden for patients. “Anytime we can safely reduce the amount of chemotherapy someone needs, we go for it,” says head and neck oncologist Anuja Kriplani, MD, MPH. “I always tell patients that I want them not only to be cancer free, but also to have a good quality of life after all of this is done.”

Key Takeaways

• HPV-related throat cancer is usually treated with 70 Gy of radiation and three rounds of chemotherapy.
• MSK researchers have shown most of these cancers can be treated with 30 Gy radiation and two rounds of chemotherapy.
• This approach greatly reduces debilitating side effects that often make eating and swallowing difficult.
• A new analysis of data from multiple clinical trials confirms the low-dose approach is effective at keeping cancer from returning while improving quality of life.

 

Dr. Lee’s research receives essential philanthropic support from the MSK Giving community, including James and Diane Rowen and Nancy and Howard Marks.

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Nancy Y. Lee discloses the following relationships and financial interests:

• Galera Therapeutics, Inc.
  Professional Services and Activities
• Merck & Co Inc.
  Professional Services and Activities
• Merck Serono
  Professional Services and Activities
• Nanobiotix
  Professional Services and Activities (Uncompensated)
• Shanghai Jo’Ann Medical Technology Co., Ltd
  Professional Services and Activities
• Shanghai Yingming Consulting Co., Ltd
  Professional Services and Activities