Modern conformal radiation therapy using techniques such as modulation, image guidance and motion management have changed the face of radiotherapy today offering superior conformity, efficiency, and reproducibility to clinics worldwide. This review assesses the impact of these advanced radiotherapy techniques on patient toxicity and survival rates reported from January 2017 to September 2020. The main aims are to establish if dosimetric and efficiency gains correlate with improved survival and reduced toxicities and to answer the question ‘Has VMAT become the gold standard of radiotherapy?’. Compared with 3DCRT, improvements have been reported with VMAT in prostate, locally advanced cervical carcinoma and various head and neck applications which leading to the shift in technology to VMAT. Other sites have observed improvement with VMAT however, the burden of toxicity and the incidence of cancer related deaths remain high signalling the need to further mitigate toxicity and increase survival. As technological advancement continues, large randomized long-term clinical trials are required to determine the way-forward and offer site-specific recommendations. These studies are usually expensive and time consuming therefore utilizing pooled real-world data in a prospective nature can be an alternative solution to comprehensively assess the efficacy of modern radiotherapy techniques.