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Biologically adaptive radiotherapy for oropharyngeal Cancer (BARitOne): An R-IDEAL stage 2a-2b technical
S Anderson1,2, M C Douglas3,4,2, R Valentine1
1Beatson West of Scotland Cancer Centre, Glasgow.
Clinical and Translational Radiation Oncology
|August 8, 2026
Summary
This study explores biologically adaptive radiotherapy for oropharyngeal cancer using MRI to guide treatment intensification for patients with poor-prognosis tumors. The BARitOne trial evaluates this novel approach for optimizing radiotherapy delivery.
Area of Science:
- Oncology
- Radiotherapy
- Medical Imaging
Background:
- Head and neck squamous cell cancer (HNSCC) incidence is rising, with poor outcomes for HPV-negative and some HPV-positive oropharyngeal cancers (OPSCC).
- Previous attempts at uniform treatment intensification for poor-prognosis HNSCC have been unsuccessful.
- Diffusion-weighted MRI (DW-MRI) can identify OPSCC likely to fail standard radiotherapy.
Purpose of the Study:
- To optimize and evaluate the feasibility of a biologically adaptive radiotherapy approach for oropharyngeal cancer.
- To enable dose-escalated radiotherapy for patients predicted to fail standard treatment.
- To individualize intensified radiotherapy for high-risk OPSCC using a biomarker-guided strategy.
Main Methods:
- The BARitOne study is an R-IDEAL stage 2a/b trial for patients with poor-prognosis stage 3-4b OPSCC receiving radical radiotherapy.
- DW-MRI is used at fractions 1 and 10 to assess tumor response (apparent diffusion coefficient changes) and stratify patients into responders and non-responders.
- Non-responders receive dose-escalation to the gross tumor volume, while responders continue standard treatment.
Main Results:
- The primary aim is to evaluate the proportion of participants completing DW-MRI guided response-adapted radiotherapy.
- This approach allows for the identification of non-responding tumors, a key step towards personalized treatment intensification.
- The study workflow is being developed and optimized for future large-scale implementation.
Conclusions:
- Biologically adaptive, DW-MRI guided radiotherapy offers an alternative strategy to uniform treatment intensification for poor-prognosis OPSCC.
- This individualized, biomarker-guided approach has the potential to improve outcomes for patients needing intensified treatment.
- The BARitOne study's findings are transferable to other tumor types, advancing precision radiotherapy.
