Is There a Place for Brachytherapy in Vulvar Cancer? A Narrative Review

Simple Summary In view of the high recurrence rates of vulvar cancer, often even after successful surgery, this article emphasises the crucial role of radiotherapy. Surgery remains the primary treatment, but radiotherapy, particularly brachytherapy (BT) either alone or in combination with external beam radiotherapy (EBRT), plays an important role in the adjuvant and primary treatment of vulvar cancer. The article highlights the advantages of BT, including improved dose precision, minimised impact on organs at risk and support for hypofractionated accelerated treatment. This narrative review provides recent data on the importance of BT in the treatment of primary and recurrent vulvar cancer, covering radiobiological, clinical and therapeutic aspects.Abstract Vulvar cancer is a relatively rare neoplasm. The essential treatment is surgery for the primary tumour. However, postoperative recurrence rates are high, even in early-stage disease when tumour-free surgical margins are achieved or in the absence of associated risk factors (lymph node metastases, deep stromal invasion or invasion of the lymphatic vascular space). Radiotherapy plays an important role in the treatment of vulvar cancer. Adjuvant treatment after surgery as well as primary treatment of locally advanced vulvar cancer (LAVC) is composed of two key radiotherapy treatment scenarios, external beam radiation therapy (EBRT) either combined or not combined with brachytherapy (BT). In a recurrence setting, where surgery is not an option, BT alone or in combination with EBRT can be used. Compared to EBRT, BT has the radiobiological potential to improve dose to the target volume, minimise the dose to organs at risk, and facilitate hypofractionated-accelerated treatment. This narrative review presents recent data on the role of BT in the treatment of primary and/or recurrent vulvar cancer, including radiobiological, clinical, and therapeutic aspects.