Combined High Dose-Rate Interstitial Brachytherapy and Stereotactic Body Radiotherapy in Unresectable Primary Vaginal Melanoma: A Case Report

Primary vaginal melanoma is a rare and aggressive malignancy with limited prospective data to guide optimal management, particularly in unresectable disease. This report describes a 40-year-old woman with unresectable, locally progressive primary vaginal melanoma refractory to first-line combination immune checkpoint inhibition. She was treated with a dose-escalated, multimodality radiotherapy approach incorporating high-dose-rate interstitial brachytherapy to the primary tumor and stereotactic body radiotherapy with simultaneous integrated boost to nodal disease. Treatment was well tolerated and resulted in a complete metabolic and radiographic response at one year. This case highlights the role of integrated, hypofractionated radiotherapy strategies in achieving durable locoregional control in patients with progressive disease despite systemic therapy.