Radiotherapy of vulvar carcinoma

The treatment of vulvar carcinoma has undergone a process of continuing cha nge in recent years in the direction of combined individualised treatment s trategies. Radical vulvectomy is avoided as far as possible,with organ-spar ing tumour excision or reduction being performed instead. Radiotherapy,asa locally effective treatment technique, has become firmly integrated as part of the adjuvant therapeutic management of the tumour bed and its lymphatic drainage. In advanced stages of disease, definitive radiotherapy is tradit ionally used as a curative form of treatment. Technical progress and modern radiation planning enable the desired dose to be administered precisely to the target tissue volume without compromising other at-risk organs. Five i ndications for irradiation are currently recognised: adjuvant irradiation of the inguinal regions following wide excision; adjuvant irradiation where the margins of resection are histologically posi tive; adjuvant irradiation after debulking tumorectomy; neoadjuvant irradiation for primarily inoperable disease; curative salvage irradiation following postoperative recurrence.