Radiotherapy in Gynecological Oncology

Gynecologic malignancies including cervical, endometrial, ovarian, and vulvar cancers represent a major cause of cancer morbidity and mortality in women worldwide. Despite progress in surgery and systemic therapy, radiotherapy (RT) remains a cornerstone in their multidisciplinary management. This review summarizes current evidence (2020–2025) on the role of radiotherapy in gynecologic oncology, highlighting modern techniques, guideline updates, and evolving clinical indications across major tumor types. Recent international guidelines (ESGO, ESTRO, ASTRO, NCCN) and peer-reviewed studies were reviewed to assess the role of external beam radiotherapy, brachytherapy, and stereotactic body radiotherapy (SBRT) in gynecologic cancers, with emphasis on survival outcomes, toxicity, and technical advances. In cervical cancer, concurrent chemoradiation followed by image-guided brachytherapy remains standard for locally advanced disease, with underutilization of brachytherapy linked to inferior survival. In vulvar carcinoma, adjuvant RT or chemoradiotherapy is indicated for positive or close margins and nodal metastases, while IMRT/IGRT improves tissue sparing and toxicity profiles. In ovarian cancer, renewed interest has emerged in consolidative and oligometastatic settings; IMRT and SBRT demonstrate favorable local control and acceptable toxicity, particularly in chemoresistant or clear cell histologies. In endometrial cancer, adjuvant RT especially vaginal brachytherapy reduces locoregional recurrence in intermediate- and high-risk groups, while molecular profiling increasingly guides adjuvant decisions. In uterine sarcomas, adjuvant RT may enhance local control in select high-risk subtypes, though survival benefit remains inconsistent. Radiotherapy continues to play a crucial role in gynecologic oncology, with modern image-guided and intensity-modulated techniques improving precision and safety. Emerging paradigms including integration with systemic and immunologic therapies, and adaptive individualized planning promise to further refine its impact on survival and quality of life in selected patient populations.