Brachytherapy in vulvar cancer: Clinical outcome and safety from a single center experience

To report clinical outcomes and toxicity of interstitial brachytherapy (IBT), with or without external beam radiotherapy, in a predominantly frail, multimorbid cohort of patients with locally advanced vulvar cancer, analyzed according to treatment intent and clinical setting.

We analyzed 47 patients with vulvar malignancies treated between 1998 and 2024 with pulse dose rate-IBT, either postoperatively or with definitive intent. Fifteen patients received pulse dose rate-IBT alone (median total dose of 57.2 Gy, range, 44.7-67.2), while 32 patients underwent combined external beam radiotherapy followed by an IBT boost (median total dose of 61.4 Gy; range, 50.7-68.1). Median age was 67 years (range, 38-90). Survival outcomes were estimated using Kaplan-Meier methods.

Median follow-up was 2.2 years (range, 4-210). Two- and five-year overall survival rates were 58.2% and 45.7%, and disease-free survival rates were 62.5% and 53.1%, respectively. Concurrent chemotherapy was administered to 22/47 (47%) patients and was not completed in 7/22 (32%). In a predefined subgroup treated with curative intent for primary vulvar cancer, five-year overall survival, disease-free survival, and cumulative local recurrence rate were 61.7%, 66.7%, and 29.3%, respectively. Severe toxicity (≥grade 3), including ulceration, occurred in 14.2% of patients.

In this real-world cohort, interstitial brachytherapy was feasible with a low rate of severe toxicity. Despite a frail, multimorbid patient population, acceptable local control was achieved. With appropriate patient selection, IBT may represent a viable option to improve local control while limiting mucosal toxicity.