Hi,

You may find in the links below some articles that address radiotherapy in the management of Vulval cancer.

Article Treatment outcomes of curative radiotherapy in patients with...

https://www.glowm.com/section_view/heading/radiation-therapy-for-vulvar-carcinoma/item/259

Good luck.

There are quite a number of references for radiation therapy in the management of vulvular carcinoma. Some ref;

- https://www.ncbi.nlm.nih.gov/books/NBK65760/#CDR0000062886__462

- Perez CA, Grigsby PW, Galakatos A, et al.: Radiation therapy in management of carcinoma of the vulva with emphasis on conservation therapy. Cancer 71 (11): 3707-16, 1993. [PubMed]

- Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins. Bedell SM, Hedberg C, Griffin A, Pearson H, Wilhite A, Rubin N, Erickson BK. Gynecol Oncol. 2019 Aug;154(2):276-279. doi: 10.1016/j.ygyno.2019.05.028. Epub 2019 Jun 3. PMID: 31171409 Free PMC article.

-The role of volumetric modulated arc therapy (VMAT) in gynaecological radiation therapy: A dosimetric comparison of intensity modulated radiation therapy versus VMAT. Knapp P, Eva B, Reseigh G, Gibbs A, Sim L, Daly T, Cox J, Bernard A. J Med Radiat Sci. 2019 Mar;66(1):44-53. doi: 10.1002/jmrs.311. Epub 2018 Nov 2. PMID: 30387550 Free PMC article.

Vulval intraepithelial neoplasia is treated by wide local excision, laser therapy or topical imiquimod, and with the availability of these lines of treatments radiotherapy for VIN is recommended since the damaging effect of its use is out of the benefit and I had not find any article which recommends or tries to use it for the premalignant condition which can take year(s) to change to malignant and the cancer itself can be treated by local excision in its early stages. In addition VIN may regress and without proven malignancy it is better not to use radiotherapy.

You can use other less aggressive tools, such as laser or the use of topical imiquimod

All cases of vulvar HSIL (high grade squamous intraepithelial lesions) should be treated with excision. If occult invasion is suspected wide local excision should be done. When occult invasion is not a concern, vulvar HSIL (VIN usual type) can be treated with excision, laser ablation, or topical imiquimod (off-label use) as per ACOG guidelines. Visual inspection of vulva should be performed at 6-months and -12 months follow-up visits (after initial treatment) and annually thereafter.

Randomized controlled trials have shown that the application of topical imiquimod 5% is effective for the treatment of vulvar HSIL (VIN usual type), although it is not approved by the U.S. Food and Drug Administration for this purpose.

Surgery is the cornerstone of therapy for women with vulval cancer involving inguinal lymph nodes. Women who are not fit for surgery can be treated with primary radiotherapy.