In a patient with previous cervix cancer treated with surgery and adjuvant EBRT who presents with recurrent HGSIL, status post vaginectomy, would you consider brachytherapy?  

I would consider advanced imaging such as MRI with vaginal gel to rule out the presence of a supravaginal lesion. Otherwise, I would not treat following excision of the HSIL lesion, even if margins were positive for dysplasia. HPV testing can be done to risk stratify. However, excision/ablation is t...