Brachytherapy Guidelines for Cervical and Endometrial Cancer

Dose Recommendations

The National Comprehensive Cancer Network recommends external beam radiation therapy (EBRT) delivering approximately 45 Gy (40-50 Gy) to the primary tumor and regional lymphatics for definitive treatment of cervical cancer 1, 2
For cervical cancer, a brachytherapy boost should deliver an additional 30-40 Gy to point A (in LDR equivalent dose) 1, 2
The total point A dose should reach 80 Gy for small-volume cervical tumors and ≥85 Gy for larger-volume tumors 1, 2
Adjuvant radiotherapy should cover the upper 3-4 cm of the vaginal cuff, parametria, and adjacent nodal basins for post-hysterectomy treatment of cervical cancer 1, 2
The standard dose for adjuvant radiotherapy is 45-50 Gy in conventional fractionation 1, 2

For HDR brachytherapy, a common approach is 5 insertions with tandem and colpostats, each delivering 6 Gy to point A 1, 2
This results in a nominal HDR point A dose of 30 Gy in 5 fractions, equivalent to 40 Gy using LDR brachytherapy 1, 2
For vaginal brachytherapy alone in endometrial cancer, 7 Gy × 3 fractions prescribed at 0.5 cm depth from vaginal surface, or 6 Gy × 5 fractions prescribed to vaginal surface is recommended 3

The target for vaginal brachytherapy after hysterectomy should be limited to the upper vagina 3
Dose should be prescribed to either the vaginal surface or at 0.5 cm depth from vaginal surface, depending on the chosen regimen 3
Patients receiving vaginal brachytherapy are prone to vaginal stenosis, which can impair sexual function, and vaginal dilators can be used starting 2-4 weeks after treatment completion and continued indefinitely 3
Modern image-guided brachytherapy techniques aim to optimize dose coverage of tumor while reducing dose to adjacent bladder, rectum, and bowel structures 1, 2