Brachytherapy (BT) is an integral component in the multimodality management of carcinoma cervix; however studies (both in developed as well as developing countries) have shown its sub-optimal use, consequently affecting survival. Elderly patients of carcinoma cervix (E-CC) are a challenging group of patients to treat. We aimed to analyse the impact of BT usage on clinical outcome of E-CC patients treated with definitive radiotherapy (RT) with or without chemotherapy (CT) at our institute. 100 patients of E-CC (≥ 60 years) registered between Jan 2009 and Dec 2015 was included in this retrospective analysis. Medical charts were reviewed for: patient demographics, stage (FIGO 2009), histology, RT and CT dose parameters and BT details. Acute toxicities were recorded as per RTOG acute morbidity criteria. Disease free survival (DFS) was estimated using Kaplan-Meier method. Statistical analysis was done with SPSS (version 21.0) and p<0.05 was considered significant. Median age was 65 (range: 60-85 years). 26 patients had stage IIB; 69 and 5 patients respectively had stage IIIB and IVA disease. Median Karnofsky performance stage was 80 (range 70-90). All had squamous cell carcinoma histology except 4 patients (adenocarcinoma). Median external beam radiotherapy dose (EBRT) was 50 Gy (range: 20-50 Gy). 25 patients (25%) received concurrent chemotherapy with weekly Cisplatin 35-40 mg/m2; median 5 cycles (range: 2-6). Acute haematological and gastrointestinal toxicity grade ≥ 3 was seen in 8% and 11% patients respectively during EBRT. 71 patients received brachytherapy; 62 patients received high dose rate intracavitary brachytherapy (ICBT; 7 Gy x 3 fractions, weekly), 7 patients received pulsed dose rate ICBT (70 cGy×39 hourly pulses, total dose 27 Gy) and 2 patients received interstitial brachytherapy 10 Gy in 2 fractions, each one week apart. 29 patients did not receive brachytherapy. 10 patients (34.48%) defaulted for planned ICBT after EBRT; 8 patients (27.58%) refused ICBT; 6 patients (20.68%) could not receive it because of poor general condition and co-morbidities and 5 patients (17.24%) received EBRT boost in lieu of BT. Median follow up was 23.6 months (range: 4-46 months). 1 year and 2 year DFS for entire cohort was 74.9% and 68.9% respectively. 1 years and 2 year DFS rate for patients not receiving brachytherapy was 24% vs. 85.9% and 11.9% vs. 82.4% respectively (p<0.001). Age (> 70 vs. 60-69 years), use of concurrent chemotherapy and stage did not impact DFS significantly. Non-receipt of brachytherapy continued to be a predictor for worse survival on multivariate analysis (HR 0.056; 95% CI 0.0183 to 0.1723). Exclusion of BT from the radiotherapeutic management of E-CC adversely impacts survival. Reasons of non-receipt may help in understanding and increasing the compliance of patients for BT and hence improving survival.