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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.