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,...