Due to an increasing incidence with concurrently decreasing age at onset, vulvar cancer represents a current challenge for gynecologic oncologists. Positive lymph nodes of the groins have been proven to be the most important prognostic factor for affected patients, significantly impairing overall survival. Distinct criteria for indication of adjuvant therapy following primary tumor resection and groin surgery are still under debate. At present, only patients with two or more positive lymph nodes are treated with adjuvant radiotherapy despite growing evidence that patients with only one nodal macrometastasis already have a significantly worse outcome and might benefit from adjuvant treatment. This review discusses existing evidence focusing on different therapeutic approaches and their potential indication in vulvar cancer. Based on the available data the need for future trials is being elaborated.
