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Advances in imaging, technology, and artificial intelligence enable radiation plans to be updated over time, improving tumor coverage while sparing normal tissues. Because bladder, bowel, rectum, and tumor anatomy can change significantly, gynecologic cancers may uniquely benefit. Preliminary studies suggest maintained tumor coverage with reduced organ exposure, and ongoing trials evaluate clinical benefits, while implementation demands substantial resources and workflow optimization.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-new-kid-on-the-block-online-adaptive-radiotherapy-in-the-treatment-of-gynecologic-cancers/385467/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-new-kid-on-the-block-online-adaptive-radiotherapy-in-the-treatment-of-gynecologic-cancers/385467.png","ImageObject",300,407,{"name":92,"@type":93},"OmBimo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What problem does online adaptive radiotherapy address compared with traditional radiation treatment?","Question",{"text":112,"@type":113},"Traditional treatments often deliver the same plan with large margins, which can miss pelvic disease and expose more uninvolved tissue. 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The New Kid on the Block: Online Adaptive Radiotherapy in the Treatment of Gynecologic Cancers. Curr. Oncol. 2023, 30, 865–874. [https://doi.org/10.3390/](https://doi.org/10.3390/)  \ncurroncol30010066  \nReceived: 2 December 2022  \nRevised: 23 December 2022  \nAccepted: 6 January 2023  \nPublished: 8 January 2023  \nCopyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \nDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA * Correspondence: [kevin.albuquerque@utsouthwestern.edu](kevin.albuquerque@utsouthwestern.edu); Tel.: +001-214-645-8309  \nAbstract: Online adaptive radiation is a new and exciting modality of treatment for gynecologic cancers. Traditional radiation treatments deliver the same radiation plan to cancers with large margins. Improvements in imaging, technology, and artificial intelligence have made it possible to account for changes between treatments and improve the delivery of radiation. These advances can potentially lead to significant benefits in tumor coverage and normal tissue sparing. Gynecologic cancers can uniquely benefit from this technology due to the significant changes in bladder, bowel, and rectum between treatments as well as the changes in tumors commonly seen between treatments. Preliminary studies have shown that online adaptive radiation can maintain coverage of the tumor while sparing nearby organs. Given these potential benefits, numerous clinical trials are ongoing to investigate the clinical benefits of online adaptive radiotherapy. Despite the benefits, implementation of online adaptive radiotherapy requires significant clinical resources. Additionally, the timing and workflow for online adaptive radiotherapy is being optimized. In this review, we discuss the history and evolution of radiation techniques, the logistics and implementation of online adaptive radiation, and the potential benefits of online adaptive radiotherapy for gynecologic cancers.  \nKeywords: gynecologic cancer; online adaptive radiotherapy; radiation oncology  \n1. Introduction  \nGynecologic (GYN) cancer is defined as any cancer originating in the women's reproductive organs. There are five major subtypes of GYN cancers including cervical cancer, uterine cancer, ovarian cancer, vaginal cancer, and vulvar cancer. About 94,000 women are diagnosed with gynecologic cancers in the US every year, with the most common GYN cancer being uterine cancer followed by ovarian cancer and cervical cancer [1] .  \nThe management of GYN cancers varies, but can involve surgery, chemotherapy, and/or radiation. Often, patients with locally advanced disease or high-risk features after surgery will receive either definitive radiation or adjuvant radiation while others may receive further radiation with brachytherapy. In this review, we will investigate the role of radiation in treating gynecologic cancers with a focus on the future role of online adaptive radiotherapy (ART) for GYN cancers, the next frontier in radiation therapy.  \n2. History of Radiotherapy for GYN Cancers  \nRadiation has long been used in the field of GYN cancers and the evolution of radiation in GYN cancers is shown in Figure 1. The first reports of radiation in GYN cancers came from the 19th century where physicians placed small pieces of radium near the cervix to treat cervical cancer [2] . In the 1960s these techniques were replaced with 2D radiation where patients were treated with external radiation based on bony landmarks using anterior-p","cbCaibRapmCgCXHs","https://ap.wps.com/l/cbCaibRapmCgCXHs","pdf",1899410,"English","# Introduction\n# History of Radiotherapy for GYN Cancers","[{\"question\":\"What problem does online adaptive radiotherapy address compared with traditional radiation treatment?\",\"answer\":\"Traditional treatments often deliver the same plan with large margins, which can miss pelvic disease and expose more uninvolved tissue. Online adaptive radiotherapy updates plans to reflect changes between sessions.\"},{\"question\":\"Why might gynecologic cancers benefit particularly from online adaptive radiotherapy?\",\"answer\":\"They can show substantial inter-treatment changes in the bladder, bowel, rectum, and in the tumors themselves. This creates opportunities to improve tumor coverage while sparing organs at risk.\"},{\"question\":\"What factors are required for implementation of online adaptive radiotherapy?\",\"answer\":\"Implementation requires significant clinical resources, and both the timing and workflow must be optimized. The review also notes ongoing efforts to manage logistics and delivery.\"}]","The New Kid on the Block - Online Adaptive Radiotherapy in the Treatment of Gynecologic Cancers | PDF",1790269395,25]