What brachytherapy regimen would you use for a patient who completed only the EBRT portion of their planned definitive chemoradiation course for locally advanced cervical cancer, who is now presenting with persistent/recurrent local disease?

I would favor exenteration.

If not possible, then would favor chemo to downsize followed by brachy or brachy alone with total dose based on cumulative dose to rectum and bladder. At least aim for EQ2 of 40 Gy or above to HRCTV with hot spot in GTV to a higher dose.