How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?  

I would favor brachytherapy alone using MRI based planning with either a multichannel or hybrid applicator. Dose 6 Gy x 6 to CTV and higher dose (hot spots) to GTV.

I think there is not much data in the gyn space to delineate potential toxicities. Radiation for patients with scleroderma raises the risks of skin fibrosis, as well as hardening of the other tissues in the radiation field. Radiation may also cause a flare of scleroderma symptoms.One study described...

I agree with Dr. @John M. Koval that it depends on size and extent. If reasonably small, e.g. <3 cm in size, I would favor brachy alone. My preferred approach is a permanent interstitial implant with Cs-131 to a dose of 55-60 Gy in this patient with no prior RT. I recognize permanent seed implant...