What is your strategy for treatment of FIGO IIB cervical cancer in a patient who poorly tolerated the first insertion and refuses subsequent insertions?

Not other equivalent options. That being said, I would plan IMRT/IGRT boost with total dose to HRCTV (75-80 Gy) based on dose to rectum, bladder, and small bowel with tight PTV margin.

Psychological distress is common in cervical cancer patients treated with brachy; it's a painful and scary procedure. At another facility, hospital-based, I've used the OR for all of my tandem and ovoid insertions, with really optimal packing that gave good dose distributions and good patient comfor...