What is your approach to a cervical cancer in a patient with a previous supra-cervical hysterectomy?

I have had 2 patients with this scenario. Given that the primary site of disease remained intact, I chose to treat fundamentally the same as I would otherwise treat an intact cervix. Both were early-stage and underwent CRT with planned insertions intended to limit total treatment length to under 56 days (we try to limit to 50 days when possible). In the first patient, at the time of first T&O insertion, we became aware that a fibroid was directly blocking the cervical os, and insertion was not possible. The initial insertion was aborted and she underwent supracervical hysterectomy and, after time to heal, we continued planned insertions using a 4cm tandem. This unplanned surgery did delay her overall treatment length, but 3 years out she is NED. The second case was referred to our department from an outside hospital (prior to start) where she underwent chemoRT for post-hysterectomy cervical cancer. We completed a “routine” course of intracavitary HDR brachytherapy using a 4cm tandem. As always, sounding and insertion were performed under ultrasound guidance. Her course was completed in under 56 days. In both patients, dose was specified to HR CTV as delineated on post-implant MRI with acceptable target coverage and dose constraints.