Electrochemotherapy for Recurrent Vulvar Cancer

Inclusion Criteria: * Local recurrence of vulvar cancer * Age ≥ 18 years * Expected life expectancy \> 3 months * Karnofsky performance status ≥ 70 or WHO performance status ≤ 2 * At least 2 weeks since last treatment * Ability to understand the procedure and possible adverse effects * Ability to provide written informed consent * Patient discussed at multidisciplinary tumor board before enrollment * Fit for anesthesia Exclusion Criteria: * Life-threatening infection and/or severe cardiac, hepatic, or other systemic disease * Significantly reduced lung function requiring DLCO testing (patients with abnormal DLCO are excluded) * Age \< 18 years * Major coagulation disorders not responding to standard therapy * Prior cumulative bleomycin dose ≥ 400 mg/m² * Chronic renal impairment (creatinine \> 150 µmol/L) * Epilepsy * Pregnancy * Inability to understand the study or refusal to participate