Whole pelvic intensity-modulated radiotherapy for gynecological malignancies: A review of the literature

•IM-WPRT is the fastest growing indication for use of IMRT.•IM-WPRT for gyn cancers has the potential for better sparing of normal tissues.•Early studies show lower incidences of morbidities than for conventional 3D-CRT.•Ongoing trials seek to validate the use of IM-WPRT for gynecological malignancies.

Radiation therapy has long played a major role in the treatment of gynecological malignancies. There is increasing interest in the utility of intensity-modulated radiotherapy (IMRT) and its application to treat gynecological malignancies. Herein, we review the state-of-the-art use of IMRT for gynecological malignancies and report how it is being used alone as well as in combination with chemotherapy in both the adjuvant and definitive settings. Based on dosimetric and clinical evidence, IMRT can reduce gastrointestinal, genitourinary, and hematological toxicities compared with 3D-conformal radiotherapy for gynecologic malignancies. We discuss how these attributes of IMRT may lead to improvements in disease outcomes by allowing for dose escalation of radiation therapy, intensification of chemotherapy, and limiting toxicity-related treatment breaks. Currently accruing trials investigating pelvic IMRT for cervical and endometrial cancers are discussed.