A retrospective study of all patients with carcinoma of the vulva treated by radiation therapy at the A. Maxwell Evans Clinic of the Cancer Control Agency of British Columbia, between 1950 and 1980, is reported. Sixty-eight patients, representing 30% of all referred patients with vulvar cancer, were analyzed for survival, recurrence patterns, complications, and clinical features. This group is companion to a series of patients treated with operation reported in 1979. The data confirm a major role for radiation therapy both in palliation and in combined radiotherapy-operation. For 13 cases, radiotherapy with curative intent was used in combination with operation resulting in a 5-year actuarial survival of 92%, with acceptable posttreatment morbidity. The advantages of preoperative radiotherapy, particularly for posterior vulvar lesions, are suggested by the data, and the need for a reappraisal of the role of radiotherapy in vulvar carcinoma is stressed.