From the data available, PDR is a safe and effective form of brachytherapy. It is also likely to have the radiobiologic advantages associated with LDR over the large doses per fraction used with HDR brachytherapy. There are practical advantages of using PDR in terms of a requirement for less shielding and, in general, the use of two rather than the four treatments used for HDR brachytherapy. However, there are insufficient data to judge the true merits of PDR over HDR as mainly single-center audits have been carried out with no direct comparison of the two approaches. Interpretation of the available literature is difficult as patient characteristics such as disease stage and treatment by skilled brachytherapists and teams are important influences on treatment outcomes. There is a clear need for a randomized trial comparing PDR and HDR brachytherapy in patients with gynecologic cancers. Until such data are available, we advocate caution and recommend the many possible changes in treatment delivery are introduced in a stepwise fashion. © 2009 American Brachytherapy Society.