title: The role of intensity modulated radiotherapy in gynecological radiotherapy: Present and future.
abstract: OBJECTIVE
  This manuscript reviews the English language literature on the use of intensity modulated radiation therapy (IMRT) for gynecologic malignancies, focusing on the treatment cervical cancer.
  
  
  BACKGROUND
  Radiation therapy plays a key role in both definitive and adjuvant treatment of these patients, although efforts continue to minimize acute and chronic toxicity. IMRT is an attractive option because of the potential to dose escalate to the target while sparing organs at risk.
  
  
  METHODS
  The English language literature was reviewed for relevant studies.
  
  
  RESULTS
  Multiple heterogeneous studies have showed dosimetric and clinical benefits with reduction in acute and late gastrointestinal, genitourinary and hematologic toxicity, especially in the post hysterectomy scenario and for dose escalation to para-aortic nodes. Consensus is evolving regarding necessary margins and target delineation in the context of organ movement and tumor shrinkage during the course of radiotherapy. Protocols with daily soft-tissue visualization are being investigated.
  
  
  CONCLUSIONS
  Consistency in approach and reporting are vital in order to acquire the data to justify the considerable increased expense of IMRT.
authors.affiliation: British Columbia Cancer Agency, Center for the Southern Interior, 399 Royal Avenue, Kelowna, British Columbia, Canada V1Y 5L3.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernandez-Ots
authors.affiliation: British Columbia Cancer Agency, Center for the Southern Interior, 399 Royal Avenue, Kelowna, British Columbia, Canada V1Y 5L3.
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
keywords: Gynecologic malignancy; Intensity modulated radiation; Radiotherapy; Toxicity