There was some thought that treatment of high risk histologies, positive LVI, or high Grade required a longer vaginal length be treated. Including 2/3 or full length. That is largely unsupported by high-quality data and would increase distal vagina toxicity in this population. Our clinic treats upp...

I don’t change the length of vaginal treatment for adjuvant brachytherapy alone based on histology.  The only thing I do differently is in high risk disease who need EBRT, I treat the larger length of vagina with EBRT followed by brachy boost to upper 3 cm only.

Anecdotally, my institution has seen a few mid vaginal recurrences in high-risk histology (serous/carcinosarcoma/clear cell) patients treated to a 'standard' distance of 3 cm of proximal vagina, which became very challenging salvage situations. Thus, I do change my treatment length based on histolo...

I also agree with what has been discussed above by @Neil K. Taunk and @Sushil Beriwal. We don't change the path length based on histology as there is limited data to support this.