Radiation oncology has undergone a major transformation in the past few years. Results of three-dimensional conformal radiation therapy and intensity-modulated radiation therapy have confirmed the promise that was evident from treatment-planning studies and early results of phase II and phase III trials. Advances in functional and metabolic imaging have augmented the tools for evaluating disease and planning treatments. Refinements of cytotoxic chemotherapy in conjunction with radiation therapy have reduced side effects and improved efficacy. The rapidly developing arena of molecular therapeutic agents and the emerging ability to select some agents based on molecular abnormalities in tumors promise to revolutionize combined modality therapy. Surgical procedures have emphasized preservation of structures, video assistance, and robotic tools such that the indications for adjuvant radiation therapy have been expanded and modified.