This study’s primary objective was to determine whether the survival benefit of adjuvant radiation for individuals with node-positive vulvar cancer is sustained in older patients. Patients aged 65 years or older diagnosed with vulvar squamous cell carcinoma between 2004 and 2017 and undergoing surgery with confirmed node-positive illness were sought for from the National Cancer Database (NCDB). Statistical analysis was performed utilizing propensity-score matching, the chi-square test, the log-rank test, Kaplan-Meier, and multivariable Cox proportional regression. 

There were a total of 2,396 patients evaluated, and 1,517 (or 63.3% of the total) got radiotherapy as adjuvant treatment. The average length of time patients were followed up with was 73 months. A median age of 77 was reached at the time of diagnosis (range 65–90). Overall survival (OS) at 5 years was 29% in the cohort that was matched based on propensity scores. The 5-year OS was 33% in patients who got surgery followed by adjuvant radiation and 26% in those who received surgery alone (P<0.0001). On the other hand, multivariate analysis still showed that patients who received adjuvant radiation had a better chance of survival (OR 0.77 [95% CI 0.69-00.87], P<0.001). Those between the ages of 65 and 84 who had adjuvant radiation had a higher 5-year OS (35% vs. 29%, P=0.0004), whereas those 85 and beyond had a lower 5-year OS (20% vs. 19%, P=0.32). 

According to the results of this NCDB analysis, radiation remains an integral part of multimodality therapy for older patients with node-positive vulvar cancer. The benefit of adjuvant radiation may be impaired by treatment-related morbidity/toxicity, making a comprehensive and geriatrics-specific approach necessary for treating older persons with node-positive vulvar cancer.