Radiotherapy and chemoradiotherapy for carcinoma of the vulva

Radiotherapy may be used in the treatment of vulval cancer as an alternative to surgery in unfit patients, as an adjuvant to surgery in patients with poor prognosis tumours and for the treatment of inoperable, recurrent and metastatic disease. High-energy X-rays, electrons and both superficial mould and interstitial brachytherapy may be integrated in the regimen to produce the maximum tumour control and minimum morbidity. Concomitant chemoradiotherapy has a high response rate and may be used before surgery to reduce the morbidity of otherwise sphincter-sacrificing procedures. This chapter presents the historical development of radiotherapy for vulval cancer, the role of radiotherapy in the treatment of the primary tumour and also the loco-regional nodes, both for prophylaxis and for proven node metastasis. Techniques for delivering radiotherapy are then discussed and are followed by protocols detailing radiotherapy and chemotherapy doses for different clinical situations.