Radiation therapy (RT) is commonly used in the treatment of gynecologic malignancies. Unfortunately, RT exposes patients to a wide variety of sequelae. Concerns over toxicity also limit the use of higher doses in select patients. To improve the efficacy of conventional RT and to explore the possibility of dose escalation, we have turned to the use of intensity-modulated RT (IMRT). This report reviews our preclinical studies, implementation, and clinical experience to date with IMRT for gynecologic malignancies.