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The use of adjuvant Whole Abdominal Radiation Therapy (WART) in gynecologic cancers has not achieved widespread use for a variety of reasons. Several phase III trials comparing WART with adjuvant chemotherapy (CT) in both uterine and ovarian cancers have demonstrated marginal improvement in survival favoring CT over WART. However, the dose of conventionally delivered WART has been historically limited due in large part to the low threshold of normal organ tolerance in the upper abdomen associated with significant late effects of the bowel and kidneys in particular. Yet, with the advent of Image-Guided Radiation Therapy (IGRT), the possibility of dose reduction to nearby organs at risk along with the potential to increase target volume dose is now obtainable. This paper will review the current data related to IGRT WART for several different patient populations of gynecologic cancers.
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