MR guided high intensity focused ultrasound (MRgHIFU) treatment plans were generated for 16 patients with recurrent gynecological tumors. Treatment volumes (i) ignoring risk to non-target regions (TVunconstrained), (ii) considering risk, assuming that patients were optimally prepared (TVoptimal), and (iii) assuming no preparation was possible (TVno-prep), were compared with planning target volume (PTV). 9/16 patients (56%) with tumor volumes ≤53 ml were considered feasible to treat safely if optimally prepared (TVoptimal≥50% PTV). Main limiting factors were transducer focal range, bone in the beam path, and risk to bowel. However, even without preparation, 4/16 patients (25%) remained feasible to treat (TVno-prep ≥50% PTV).