Would you treat Vaginal intraepthelial neoplasia 3 with HDR brachytherapy?

This is an option for persistent VAIN3 despite surgery and topical agent

I have treated with 6 Gy x5

Important principal is where you are presecribing dose. Previous HDR studies have shown high complications because entire length was treated to fixed depth of 5 mm or so. The vaginal wall thickness varies from proximal to distal part. we treat with MRI based planning prescribing to vaginal thickness in the top ( usually 1-3 mm) and surface in distal vagina

Surgical resection is the treatment of choice for women with VAIN, but there are other acceptable approaches such as wide local excision, CO2 laser, electrocoagulation, and topical 5-FU. Vaginal brachytherapy has been described both using LDR and HDR techniques, and for the most part, with fairly positive results - control rates between 80-100%, identifying that brachytherapy can be an effective treatment of VAIN. The LDR techniques relied on treating the entire length of the vagina, and delivering 50-60Gy to the surface, and up to 70Gy to the site of involvement. This LDR dose would be broken up into 2 treatments. With the transition to HDR, the dosing regimen of choice becomes more challenging. Several series have documented good control ...