In the IMRT era, what role does brachytherapy play in the treatment of squamous cell carcinoma of the vulva?

We very rarely use brachytherapy to treat vulvar cancer because our experience (and that of others) has been that the rates of necrosis with brachy are very high. Any source that comes too close to the vulvar surface will cause necrosis that typically heals very slowly. Even with the best technique, it is difficult to control the skin dose. The only exception would be an occasional tumor that is mostly vaginal but is classified vulvar because it extends a bit distal to the hymenal ring into the vestibule. Frankly, except for a few such cases and one unusual presentation of a Bartholin's tumor, I don't think I have treated a vulvar case with brachy in more than 25 years. Luis Delclos treated quite a few in the 60s and 70s but, as mentioned, ...