Approximately 50% of cancer patients require radiotherapy (RT) during their treatment. In addition to
concurrent systemic therapies for curative or adjuvant purposes, metastatic disease will require conventional
fractionation or stereotactic body RT/radiosurgery (SBRT/SRS). Recently, the number of systemic
treatment options has increased significantly with the introduction of immune checkpoint inhibitors
(ICIs) and a wide variety of targeted agents. It is important for the radiation oncologist to be knowledgeable
about targeted therapy and immunotherapy agents used in gynecologic malignancies, their side
effects, and their management. Unexpected serious toxicities, such as hypertension, bleeding, thromboembolism,
and a 1-2% risk of gastrointestinal perforation, can occur with bevacizumab. Therefore,
concomitant administration of bevacizumab and RT is currently not recommended outside of clinical
trials. An increased risk of side effects has been reported when the interval between bevacizumab and
RT is <10 months. Several studies showed the association and low toxicity profile of SBRT and poly
ADP-ribose polymerase inhibitors (PARPis) in patients with oligometastatic ovarian cancer. Although
the concurrent use of programmed cell death protein 1/programmed cell death-ligand 1 (PD-1/PD-L1)
inhibitors and RT seems appropriate in the treatment of gynecological malignancies, more data are
needed regarding their use with other agents.
Keywords: Adverse effects; endometrial neoplasms; immunotherapy; ovarian neoplasms; radiotherapy; targeted molecular therapy; uterine cervical neoplasms
