How do you decide whether to treat proximal vs. entire vaginal cuff with intracavitary brachytherapy in early-stage endometrial adenocarcinoma?

At M.D. Anderson - we never treat the entire vagina for early stage endometrial carcinoma. In fact, we only treat the proximal 2.5 to 3.0 cm of the vagina in most case but may increase with by 1.0 cm for patients with papillary serous or carcinosarcoma histology with brachytherapy. We have excellent...

For early stage endometrial cancer, we almost never treat the entire vagina, as the percent of recurrences in the distal vagina is very low and vaginal morbidity increases significantly with treatment of entire vagina. For patients who are at increased risk of distal vaginal recurrence (extensive LV...