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...

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, albei...