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What is the optimal interval between vaginal cuff brachytherapy sessions?

At our institution we often give 5.5 Gy x 4 fractions. There really does not appear to be a general consensus regarding timing. Interested in what other providers do as far as treatment sequence, i.e. only two factions per week or three per week (separated by 48 hour's).
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Radiation Oncology · University of Texas MD Anderson Cancer Center
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At MD Anderson, we give 6 Gy x 5 to the surface and we most often treat every other day. However, given the low risk of toxicity, we think it's safe to make adjustments to this schedule. For example, we often do some treatments on sequential days if that's preferred for any reason. We also schedule ...

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Radiation Oncology · UAB Department of Radiation Oncology
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At UAB, we gave 7 Gy x 3 = 21 Gy at 0.5 cm at the depth, treating every other day but we can vary somewhat the treatment interval according to patient transportation.

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Radiation Oncology · Vanderbilt-Ingram Cancer Center
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PORTEC-2 did 7 Gy x 3 to 0.5cm depth once per week, which is the approach I use for anyone receiving that fractionation scheme, including patients receiving cuff + chemo.

If q3 week CarboTaxol is involved, I shuffle the schedule slightly with the goal of completing VCB between cycles of chemo, but my...

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Radiation Oncology · Nebraska Cancer Specialists
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The standard at my current institution follows the PORTEC-2 regimen, delivering 7 Gy x 3 to 0.5 cm depth once weekly. However, I am planning to change our standard to twice weekly. Where I trained, we typically did 5.5 Gy x 4 to 0.5 cm depth twice weekly.

Per the ABS Guidelines (Small Jr et al., PMI...

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Radiation Oncology · Tampa Bay Radiation Oncology
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For 10 years, I have been doing VCB at 700 cGy x 3 to 5 mm primarily and at 400 cGy x 3 to 5 mm as a boost on a Tuesday–Friday–Tuesday schedule (3 fractions over 1 week). It has been very well-tolerated and I am not aware of any recurrences at the cuff.

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