Following discussion at an MDM, adjuvant radiation therapy may be recommended.

The decision about the type of radiation therapy will be based on risk factors. For intermediate-risk patients, adjuvant vaginal vault brachytherapy may be recommended to improve local control. For high-risk patients, external pelvic beam radiotherapy with or without chemotherapy may be recommended to improve survival. There may be some situations where adjuvant vault brachytherapy to external beam radiation therapy may be considered.

In selected cases, where surgery is inappropriate, radiation therapy may be offered as part of primary treatment following discussion at an MDM.

Some patients may benefit from radiation therapy for symptomatic relief and palliation of metastatic or recurrent disease, following discussion at an MDM.

Timeframe for starting treatment

• Radiation therapy as a primary treatment should begin within six weeks of the MDM.
• Radiation therapy as an adjuvant treatment should begin within eight weeks following surgery.

Training and experience required of the appropriate specialists

Radiation oncologist (FRANZCR or equivalent) with adequate training and experience that enables institutional credentialing and agreed scope of practice within this area. The radiation oncologist must be part of a gynaecological oncology multidisciplinary team.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• brachytherapy service
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience and brachytherapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• coordination for brachytherapy at an alternative centre if not available at a local centre
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system.