What small bowel dose constraints do you use in gyn brachytherapy?  

There is no good outcome data available with this, although some dosimetric studies have limited 2 cc to 60-65 Gy (EQ2). That being said, it is important to monitor at each fraction the closest loop of small bowel and attempts should be made to avoid any hot spots and to spread out that dose to diff...

I agree with all of Sushil's comments.  One thing I also like to stress is that there are two components that contribute to long term bowel health---the maximum dose received and the overall average bowel dose. Although we try to keep the 2 cc max to less than 60-65, some patients (particularly...

I agree with both Sushil's and Patricia's comments. If there is significant small bowel near an implant - differential bladder filling and brachytherapy fractionation can help. One of the worst complications to have is disease recurrence and, at times, exceeding these constraints may be necessary fo...