The goal of the study was to evaluate clinical outcomes for women with isolated vaginal recurrence of endometrial cancer after hysterectomy without adjuvant radiation or chemotherapy, who received salvage treatment with both external beam radiation therapy (EBRT) and high dose rate (HDR) brachytherapy. 30 women with recurrences treated between 2000 and 2010 were included in this single institution retrospective study. Median time to recurrence from surgery was 16.7 months, range 3.2 to 170.7 months. Median age at recurrence was 73 years, range 57 to 94 years. Initial histology was endometrioid adenocarcinoma in 25 patients (83%); others were papillary serous, clear cell, or adenosquamous. Initial disease was known to be grade 1 or 2 in 19 patients (63%), and 2009 FIGO stage IA in 19 patients. All patients received pelvic EBRT in 1.8 Gy daily fractions to a total of 45 or 50.4 Gy. Interstitial brachytherapy was used in 27 patients (90%) and 3 received intracavitary brachytherapy only. CT-based inverse planning was used for all patients. The median brachytherapy EQD2 dose was 24 Gy, range 16 to 33.3 Gy. The median total EQD2 dose was 68.3 Gy, range 63 to 77.6 Gy. Three patients received concurrent hormonal or cytotoxic systemic therapy with salvage radiation. Kaplan-Meier estimates of overall survival (OS), cause specific survival (CSS), progression free survival (PFS), locoregional failure free survival (LRFFS), and distant failure free survival (DFFS) were calculated. Univariate Cox proportional hazard ratio models were used to identify features prognostic for outcomes. Median follow-up for vital status was 76.4 months, range 10.8 to 149.2 months. Median follow-up for disease status was 57.7 months, range 0 to 103.3 months. At last follow-up, 12 patients (40%) had died of which 7 (23%) were due to endometrial cancer progression. At last follow-up for disease status, 8 patients (27%) had known disease recurrence after salvage, with 3 patients (10%) recurring locoregionally and 5 patients (17%) recurring with distant metastases. Of the 3 patients with locoregional failure, 2 had died. Of the 5 patients with distant failure, all 5 had died. The 5-year Kaplan-Meier estimated OS, CSS, and PFS were 77%, 83%, and 75% respectively. The 5-year LRFFS and DFFS were 87% and 86%. Initial grade of disease (1-2 vs. 3) was prognostic for OS, CSS, and DFFS (5-year OS 95% vs. 29%, p = 0.005). Initial stage of disease (IA vs. >IA) was prognostic for CSS, PFS, and DFFS (5-year CSS 93% vs. 74%, p = 0.025). Initial stage remained prognostic for DFFS when restricted to 23 patients with stage IA or IB disease only (5-year DFFS 100% vs. 50%, p = 0.043). There was one treatment related death, otherwise no reported grade ≥ 3 toxicity. Salvage EBRT and HDR brachytherapy resulted in a high rate of long-term locoregional control. Initial higher grade and higher stage disease were associated with distant failure and cancer related mortality.