High-Dose Rate Salvage Interstitial Brachytherapy: A Case-Based Guide to the Treatment of Therapeutically Challenging Recurrent Vulvar Cancer

Abstract

Vulvar cancer is a rare gynecological malignancy with incidence rates steadily increasing over the past 10 years. Despite aggressive treatment, recurrent disease is common. Vulvar cancer recurrence poses a significant therapeutic challenge as most patients have been previously treated with surgery and/or radiation limiting the options for additional treatment. There are no consensus guidelines for the treatment of recurrent disease. Current literature supports the use of salvage interstitial brachytherapy. However, the total sample size is small. The goal of this case report is to review the current literature and to provide a guide for the use of salvage interstitial brachytherapy for recurrent disease by describing, in detail, the techniques used to treat two patients with unique cases of vulvar cancer recurrences in women with advanced disease and multiple medical comorbidities.

Recommendations of the Spanish brachytherapy group of the Spanish Society of Radiation Oncology and the Spanish Society of Medical Physics for interstitial high-dose-rate brachytherapy for gynaecologic malignancies

“…For postoperative recurrences, the recommendations are the same as in de novo tumours [ 51 , 52 , 73 ]. In recurrences after previous irradiation, it is essential to personalise the treatment approach, especially given the scant published data in this clinical setting [ 3 , 52 , 53 , 74 , 75 ]. The total dose (EBRT or BT alone, or combined treatment) should be expressed in radiobiologically-equivalent doses of 2 Gy/fraction; always taking into account the 2 Gy biologically-effective dose (BED) received for the previous treatment and the time elapsed between the two treatments.…”

Response to External Radiation and Interstitial Brachytherapy in Bulky Vulvar Cancer

“…6 The incidence is 2-3 per 100.000 and it has continually been increasing during the last 10 years. 12 Based on GLOBOCAN 2018 data, there are 1153 new cases in Indonesia with up to 420 deaths. 3 This disease progresses slowly, with a peak incidence in the 7 th and 8 th decade of life.…”