What radiation dose/fractionation would you consider for palliation of an unresectable vulvar cancer that received previous definitive radiation therapy?

For patients with recurrence after definitive vulvar irradiation, surgery is the best option, if possible.

If this is not possible, then the retreatment with radiation can only be palliative to reduce pain or bleeding.

Depending upon the extent of recurrent disease - a dose of 3000cgy in 10 fractions may be considered, which is what I have used.

There is a small case series by Kunos et al., PMID 18783287 using SABR for a dose of 24Gy in 3 fractions.

Brachytherapy may be considered but may be associated with a high risk for necrosis.