233 / 1119
w = 1.0
cm
h = 1.0
cm
t = 1.0
cm
w
Dose of EBRT
Gy
0.5cm
IIA
Vagina:
0.3
cm
Note: the small extension of vaginal involvement can be measured
only on clinical exam. In this case, it can be included in w.
45
/ /
dd/mm/yy
Signature
At Diagnosis
At Brachytherapy
X