What is your approach to adjuvant vaginal cuff radiation in patients with prior definitive pelvic radiation therapy?

I do take the previous dose into account.

Sometimes use a multichannel cylinder and try to control the rectum and bladder dose.

Also, prescribe lower end of acceptable dose schedule like 6 Gy x 5 to surface or 4 Gy x 6 to surface.

If a woman has a remote history of pelvic radiation (45-50 Gy) for a prior malignancy, I typically use the same criteria to evaluate them for vaginal brachytherapy as I would if they had not had prior radiation.