Radiotherapy for gynecologic malignancies

This review highlights the curative potential of radiation in gynecologic malignancies. The controversies concerning the role of surgery in the management of bulky cervical cancer is discussed. Prognostic factors associated with improved pelvic control with radiation alone are described, particularly the bulk of pelvic disease, which is not accounted for in the current International Federation of Gynecology and Obstetrics staging system. The potential for integration of radiation and chemotherapy into the management of vulvar cancer to improve cosmesis and function as well as to reduce the risk of locoregional recurrence is described. The role of whole abdominal radiation in the management of advanced endometrial and ovarian cancers as well as the role of hyperfractionation to reduce acute morbidity of large abdominal fields is reviewed. Prognostic factors associated with locoregional and distant failure for endometrial cancer are outlined and the new pathologic staging system is critically analyzed. Finally, the treatment of vaginal cancer with radiation alone (external beam plus interstitial-intracavitary radiation) or surgery is reviewed and the prognostic importance of the present modifications to the vaginal staging system are emphasized.