What is the longest interval to proceed with brachytherapy boost for cervical CA after EBRT?

Ideally, treatment should be completed in 56 days (preferably < 50 days). If there has been a significant delay to brachytherapy (>2-3 months) due to insurance issues and transfers of care would you re-image and proceed with implant? EBRT boost? Is there a point at which patient should not undergo brachytherapy and wait to treat at recurrence?

Unfortunately, 3 month post-EBRT/pre-brachy PET showed progression in para-aortics (which were not included in initial fields).

Answer from: Radiation Oncologist at Community Practice

I would proceed with brachytherapy even after a delay of 2-3 months as that is still better than no brachy and if local recurrence occurs, then the patient would need exenteration. Another option to consider, if imaging and scan show great response to EBRT, it is the possibility of a hysterectomy. ...

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Radiation Oncologist at Radiotherapy Cancer Center (RTCC)
If the patient had a treatment break during brachy...

Answer from: Radiation Oncologist at Academic Institution

I agree with @Sushil Beriwal. Additional external beam RT to the central disease would have little or no benefit and would increase risks. I would proceed with brachytherapy unless the GTV is very large. If the cervix is <4 cm, you may be able to deliver 50-60 Gy EqD2 to the HRCTV without exceedi...

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What is the longest interval to proceed with brachytherapy boost for cervical CA after EBRT?

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