We have been used MR images for brachytherapy for cervical cancer with the purpose of getting more conformal dose distribution and also reducing late morbidity. We evaluate whether this technique is less toxic than our historical data using Manchester system. Between January 1995 and December 2000, 60 patients with histological confirmed squamous cell carcinoma of the uterine cervix (FIGO Stage Ib: 7, stage IIb: 25, stage IIIb: 20, stageIVb: 7) were treated with external irradiation and MR image guided intracavitary HDR brachytherapy. Average age of the patients was 61.3 years (range: 33–85 years). Median follow-up duration was 46 months (range: 5–103 months). All patients were treated 30Gy whole pelvic irradiation followed by 20Gy boost to parametrium. Both CT and MRI were performed at the first and third time of brachytherapy under CT-MR compatible applicator insertion. The GTV was defined as high signal intensity region obtained MRI. The PTV was defined as a volume, which include 1cm margin in cranio-caudal directions. We delivered 6Gy/fraction to the PTV, one fraction /week, to a total dose of 24Gy. Until 1994, 332 patients were treated with same external irradiation technique followed by Intracavitary brachytherapy using Manchester system optimization (6Gy /fraction to a total dose of 24Gy to Point A). The 5-year survival rates according to stage, average Point A dose, maximum rectal, bladder dose and late genitourinary morbidity rates were compared between the two groups. In IGRT group, ten patients have died of their cancer and two died of intercurrent disease without evidence of recurrence. The 5 year overall survival and RFS rates according to stage in IGRT group were as follows; stage Ib: 100%, 85.7%, stage IIb: 86.5%, 100%, stage IIIb: 67.5%, 78.3%, stage IVb: 50%, 44%, respectively. Average point A dose was 496cGy (ranged: 102–710cGy). The average maximum rectal dose was 549cGy ± 214cGy in IGRT group and 1000cGy ± 640cGy in non-IGRT group, respectively. The average maximum bladder dose was 594 ± 180cGy in IGRT group and 1210cGy in non-IGRT group. The 5 year overall survival rate according to stage in non-IGRT group were as follows; stage Ib: 90%, stage IIb: 75%, stage IIIb: 52.3%, respectively. Grade1 late morbidity of bladder was observed in 2/60. Grade 1 and 2 late rectal morbidity was observed in 10/60 and 2/60, respectively. No cases were observed greater than Grade 3 morbidity at 5 years in IGRT group, whereas late rectal morbidity in non IGRT group was as follows; Grade 1: 21% (70/332), Grade 2: 9.7% (32/332), Grade 3: 5.7% (19/332), respectively. We have shown that IGRT using MRI for cervical cancer is less toxic than non-IGRT technique and the survival rate using IGRT was equal to or better than non-IGRT