A woman may develop cancer in any of the reproductive organs, including the vagina, ovary, and uterus (cervix or endometrial). Very early cervical cancer and early endometrial cancer are usually highly curable with surgery alone. More advanced cancers of the vagina and uterus have a greater tendency to involve lymph nodes in the pelvic area and sometimes in the lower abdomen along the spine. These malignancies are treated with radiation portals that encompass the primary disease and the lymph nodes at risk for 5-6 weeks. Frequently radioactive sources are temporarily placed in the vagina, the cervix, the uterus, or tissues around the uterus either during or after external beam irradiation (brachytherapy) to increase the dose to the primary tumor. External beam irradiation using Tomotherapy allows delivery of full radiation doses to suspicious or involved lymph nodes, while simultaneously limiting the dose to the small intestine. This reduces acute side effects during treatment and should result in a lower incidence of long-term bowel complications.

Ovarian cancer is frequently advanced when diagnosed and is treated with surgery and chemotherapy. If the cancer is not cured by this approach it can involve multiple areas within the abdomen and pelvis. With conventional radiation treatment it is difficult to deliver a high enough dose of radiation to control bulky abdominal disease, because of the sensitivity of the adjacent small intestine, kidneys, and liver. Tomotherapy can permit escalation of radiation dose in these bulky areas while still limiting the dosage to small intestine within the tolerance of these tissues.