Hypofractionated Radiotherapy in Gynecologic Malignancies-A Peek into the Upcoming Evidence

Simple Summary Radiotherapy (RT) is often part of the curative intent treatment in gynecologic oncology. In cervical and uterine cancers, RT is typically delivered daily over five weeks. Recently, advances in technology have allowed for higher doses of RT to be given per fraction with an overall shorter treatment time. This treatment course, called hypofractionated RT, has become the standard of care in other pelvic sites such as the prostate and rectum and is being investigated in gynecologic malignancies. In addition, hypofractionation offers a potential solution in low-resource settings where there is insufficient access to radiotherapy as with the challenges faced during the COVID-19 pandemic worldwide. This review summarizes the rationale and application for hypofractionation, the available literature and ongoing clinical trials in the gynecologic space.Abstract Radiotherapy (RT) has a fundamental role in the treatment of gynecologic malignancies, including cervical and uterine cancers. Hypofractionated RT has gained popularity in many cancer sites, boosted by technological advances in treatment delivery and image verification. Hypofractionated RT uptake was intensified during the COVID-19 pandemic and has the potential to improve universal access to radiotherapy worldwide, especially in low-resource settings. This review summarizes the rationale, the current challenges and investigation efforts, together with the recent developments associated with hypofractionated RT in gynecologic malignancies. A comprehensive search was undertaken using multiple databases and ongoing trial registries. In the definitive radiotherapy setting for cervical cancers, there are several ongoing clinical trials from Canada, Mexico, Iran, the Philippines and Thailand investigating the role of a moderate hypofractionated external beam RT regimen in the low-risk locally advanced population. Likewise, there are ongoing ultra and moderate hypofractionated RT trials in the uterine cancer setting. One Canadian prospective trial of stereotactic hypofractionated adjuvant RT for uterine cancer patients suggested a good tolerance to this treatment strategy in the acute setting, with a follow-up trial currently randomizing patients between conventional fractionation and the hypofractionated dose regimen delivered in the former trial. Although not yet ready for prime-time use, hypofractionated RT could be a potential solution to several challenges that limit access to and the utilization of radiotherapy for gynecologic cancer patients worldwide.