Do you recommend adjuvant radiation for a recurrent pT1bN0 vulvar carcinoma?

For recurrence disease, if the depth of invasion is more than 1 mm and nodal assessment is not done then would favor/discuss RT. Data shows with each recurrence, risk of nodal involvement (15%) goes up which is hard to salvage Grootenhuis et al., PMID 26428940.

Unfortunately, recurrent vulvar cancers have a poor prognosis with salvage radiotherapy.

Early reports utilized radiation therapy often without chemosensitization and modern techniques.

More modern retrospective series demonstrate salvage rates of approximately 20%. Laliscia et al., PMID 26722070

As patients now often have fewer inguinal lymph node dissections and fewer aggressive primary vulvar surgeries, local failures will likely increase with field cancerization.

With IMRT-reduced toxicity and HPV-directed therapies likely on the horizon, I favor radiation therapy in these patients regardless of nodal evaluation, especially with proven HPV positivity which may potentially respond better to therapy. Woelber et al., PMID 34794839.

Due to t...

Most true vulvar cancer recurrences (meaning disease along the post-op cavity, not a new primary within a separate portion of the vulva), even if re-excised, will have margins within 5 or 8 mm which is my usual threshold below which to recommend EBRT for LR benefit even in the upfront setting, albeit understanding the recent challenge from Netherlands group (Grootenhuis et al., PMID 31109660).

I have treated every recurrent vulvar cancer that I have seen (assuming no history of previous RT) in the adjuvant setting due to this margin threshold. I suppose if surgical margin on re-excision was truly > 8 mm then perhaps I could consider observing (again).

However, if dVIN at margin, the optimal answer is additional re-excision.

In my opinion, bett...