The first step is to be absolutely certain that brachytherapy is not feasible. In our experience this is extremely rare. The patient should have a thorough medical evaluation and have their medical conditions optimized as much as possible before the decision is made to withhold these standard elemen...

I would reiterate what Dr, Eifel stated – it should be extremely rare not to be able to provide brachytherapy. In 24 years of treating cervical cancer, I have never not delivered brachytherapy for a medical comorbidity.

I would emphasize one other point made in @Patricia J. Eifel's response.  We cured many patients with cervical cancer using RT alone, before concurrent chemotherapy became standard.  If a patient cannot receive or doesn't accept chemotherapy as part of the treatment, cure is still possible...