What is your strategy to deliver EBRT, brachytherapy, and a parametria/lymph node boost in less than 7-8 weeks for cervical cancer?

These are the things we do to accomplish this:

1) Up-front planning for the entire course. Schedule brachys before the start of external beam, particularly if you are dependent on an OR, gyn oncologist or anyone else who might require advance notice. The first brachy should be scheduled no later than 1-5 days after end of 45 Gy (preferably <3).

2) Counsel the patient on the first day and reinforce weekly the reasons for avoiding missed treatments and explain the importance of the brachy. They are less likely to miss treatments if they understand the reason for the tight schedule.

2) Make up for any holidays or other missed days with BID treatments.

3) Treat 5 days per week. If you give HDRs during external, consider bid of external (6 hr in...