In this study, a new, low cost packing system ("BrachyGel VHPS") is being tested as a packing option during brachytherapy along with standard options to make sure that it keeps the unrelated organs away from radiation at least as well as the standard options, and to better understand the safety and patient discomfort associated with BrachyGel VHPS and the standard packing options.

As part of vaginal brachytherapy, the organs that do not need to receive radiation (unrelated organs) are moved out of the way of the radiation with a "packing system". The usual low cost and available standard of care packing systems to move these unrelated organs out of the way can sometimes be uncomfortable for the patient, may not move all of the unrelated organs all the way out of the radiation's path, and rely on the doctor to place them correctly.

If you participate, you will receive 5 fractions of brachytherapy according to standard clinical care. For three of the fractions, a standard packing option will be used and for two of them BrachyGel VHPS will be used. For the first fraction both groups will have the same packing option but participants will be randomized to either have BrachyGel during fractions 2 and 4 or during fractions 3 and 5. You'll be asked to complete a questionnaire after fractions 2-5 to get your feedback on any discomfort you have during or after brachytherapy from the packing system.

Inclusion Criteria:

1. Biopsy showing cancer of the cervix (squamous cell carcinoma, adenocarcinoma, adenosquamous, neuroendocrine, etc)
2. FIGO IB1 - IVB Staging according to FIGO and TNM guidelines
3. Planning to receive brachytherapy as a part of the definitive treatment for cervical cancer
4. Karnofsky performance status (KPS) ≥ 70 or ECOG status ≤1
5. Stated willingness to comply with all study procedures and availability for the duration of the study
6. Age ≥ 18 years
7. Agreement to adhere to Lifestyle Considerations throughout study duration

Exclusion Criteria:

1. History of pelvis or abdominal radiation therapy (RT) that is not a part of the definitive treatment plan for the cancer of interest"
2. History of total or partial hysterectomy
3. Plan to receive external beam RT (EBRT) alone as the definitive treatment plan for the cancer of interest
4. Known pregnancy or lactation (no pregnancy test required prior to participation)
5. Known contraindications to brachytherapy

From completion of the 2nd brachytherapy treatment to 1 month after the last brachytherapy treatment (up to 70 days)

Adverse events were not collected before the 2nd brachytherapy treatment. The 1st brachytherapy treatment is considered a part of baseline and was performed using gauze per standard of care for all subjects. The time from informed consent to 2nd brachytherapy was up to 14 days and the time from 1st brachytherapy to 2nd brachytherapy was up to 12 days.

The limitations of this study include unblinded participants, lack of MRI for treatment planning, and a smaller than planned sample size. The study was designed as a non-inferiority trial with a planned accrual of 40 participants (20 per arm); however, the trial accrued 20 participants. No formal statistical significance calculations were performed.