This study examines the magnitude of tumour dose enhancement achieved by injection of gadolinium or iodine contrast media (CM) and treatment using modified x-ray photon spectra from linear accelerators. Monte Carlo modelling of the linear accelerator and patient geometry was used to explore the effect of removing the flattening filter for various beam qualities and the resultant effect on dose enhancement. In addition, ionization measurements were conducted to observe dose enhancement within a phantom containing CM. Simulation results indicate that for flattened 6-24 MV photon beams and realistic CM tumour concentrations, the dose enhancement remains below 5%. However, if the flattening filter is removed, dose enhancement is increased significantly. For a 30 mg ml(-1) gadolinium CM tumour concentration, for example, 8.4%, 10.8%, 13.7% and 23.1% dose enhancements are achieved for 18 MV, 6 MV, 4 MV and 2 MV unflattened beams, respectively. In contrast to the phototherapy technique, which uses the orthovoltage beam from a modified CT scanner to achieve dose enhancement, all unflattened spectra preserve the dose build-up at the surface, and thus the skin and bone are spared.