What uterine risk factors do you consider when recommending VBT boost after EBRT?

Since most patients who need EBRT now have high risk disease with more than one adverse factor, we prefer EBRT 45 Gy in 25 followed by 5 Gy x 2 for almost all unless the patient declines brachytherapy.

Evidence favoring the addition of VBT to external beam pelvic RT is lacking, no matter the pathologic findings. Having said that, I think it is reasonable to offer brachy in addition to XRT for stage II disease and/or clear presence of LVSI. Another option in these cases is to use a concomitant boos...

No clear guidelines of when to offer VBT boost. I think about what factors put patients at an increased risk of vaginal recurrence, as opposed to pelvic recurrence.

I consider cervical stromal involvement or positive vaginal margins a 'hard' indication, personally.

I do offer VBT boost for lower ute...

Our rad onc group has agreed to boost pT2 or positive vaginal margin only. Data is lacking throughout but we have chosen not to cuff boost - for example - Grade 3, LVI, LUS invasion, N+, or high risk histology. This is mostly for uniformity across our entire practice.