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Evidence from this patient group at high risk for ECE suggests that high tumor control rates are possible when utilizing Pd-103 brachytherapy and supplemental beam radiation. It is encouraging that the failure rate decreased to near zero with follow-up beyond 5 years. Despite a perception that brachytherapy is not appropriate for patients at high risk of ECE, this series strengthens the rationale that brachytherapy-based treatment may, in fact, be a very desirable treatment modality for such patients.
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