Radiation treatment of recurrent carcinoma of the vulva.

Recurrent vulvar cancer after surgical treatment carries a poor prognosis and poses a clinical therapeutic problem. Retrospective analysis of 21 recurrent vulvar cancers treated by radiation alone over 20 years (1958-1977) is presented. Highly individualized interstitial brachytherapy was used alone in some selected cases and combined with external beam therapy in most cases. The results showed that limited disease in the introitus and introitus involving the vagina have the best prognosis (6/6; 100%). Small groin node has a good chance for cure (2/4; 50%), while all extensive recurrences have the worse prognosis as expected. Factors responsible for the success of radiation treatment appear to include size and depth of the recurrence (5 cm or less lesion has a high chance for cure); groin node (less than or equal to 2 cm has good prognosis); perineal skin involvement (the lesser, the better); degree of tumor tissue necrosis (the lesser, the better); and radiation dose (5500-8500 rad). Integration of the external beam and brachytherapy and individualization with good planning are essential to achieve a better cure rate. Attempts were made to recommend a criteria for patient selection for cure and method of treatment as well as a technical aspect of the treatment.