660 / 1332
w = 3.8
cm
h = 2.5
cm
t = 4.0
cm
w
X
Dose of EBRT
Gy
3.8cm
IIA
Vagina:
1.5
cm
Note: extension of vaginal involvement is specified
separately, and should not be included in h
/ /
dd/mm/yy
Signature
At Diagnosis
At Brachytherapy