Pros and cons of vaginal brachytherapy after external beam radiation therapy in endometrial cancer

•Stage I endometrial cancer outcomes may not be improved by vaginal brachytherapy after beam (EB + VB).•EB + VB may improve local-regional recurrence in high-risk endometrial cancer (e.g. stage II-III).•A randomized prospective clinical trial is needed to determine the role for EB + VB

A large number of studies have looked at the role of radiation therapy in the treatment of endometrial cancer. One particular radiation strategy in common practice is the use of adjuvant external beam (EB) radiotherapy followed by vaginal brachytherapy (VB). While the addition of VB to EB provides a theoretical benefit of a localized boost with higher focused dose to an area of potentially high recurrence risk, a randomized clinical trial to compare outcomes and toxicities of EB + VB vs. EB alone is lacking. The goal of this review is to present the current data for and against the use of this combined radiation modality and to provide some preliminary evidence regarding which patient populations may be most likely to benefit.