How would you manage a patient with a subcentimeter stage I vaginal squamous cell carcinoma after a positive deep margin post local excision?   

I would get MRI with vaginal gel done along with PET/CT (assuming negative)  If there is no LVSI on pathology, disease is not high grade and based on MRI, I would cover vaginal wall apical residual thickness with intracavitary brachytherapy then I would treat with 7Gy x5 prescribed to volume a...

You did not mention where the lesion is. Treatment may differ if the lesion is apical vs distal, etc., so it is difficult to give specific technical recommendations.That said, we virtually always treat with a combination of external beam RT and brachytherapy for invasive vaginal cancers. In our pape...