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Purpose/objective(s): The purpose of this study was to compare clinical outcomes between black and white females treated with curative intent for vulvar squamous cell carcinoma (VSCC) and identify factors that correlate with locoregional control (LRC) and survival.Materials/methods: Patients with VSCC treated with either adjuvant or definitive radiotherapy with curative intent from 2009-2020 within our multi-center academic medical system were retrospectively analyzed. Patient and treatment-specific factors were evaluated. Kaplan-Meier and Univariate Cox proportional hazards models were used to estimate and assess factors correlated with LRC, progression free survival (PFS) and overall survival (OS). Comparisons between groups were performed using the log-rank test.Results: We identified 39 patients with VSCC treated with curative intent; 43% (n = 17) received adjuvant RT and 56% (n = 22) received definitive RT to a median dose of 59.4 Gy and 64.4 Gy, respectively. Thirty-four patients received external beam radiation therapy (EBRT) alone, 5 pts received EBRT plus brachytherapy and 22 patients received concurrent chemotherapy. The cohort was comprised of 22 black patients (BP) and 17 white patients (WP) with a median age of 62 (range: 32-93) and 68 (38-98), respectively. Median follow up for the entire cohort was 12.5 months (Q1-Q3: 2.8-31.3mos) for all patients and 14.9 months (3.8-33.2) for alive patients. BP were significantly more likely to present with clinical FIGO stage I/II (73% vs 24%, P = 0.002), undergo surgical resection (68% vs 18%, P = 0.002) and to have HPV-positive tumors (55% versus 29%, P = 0.012). 6 BP were HIV-positive versus 0 WP. There was no difference between the groups in relation to smoking status (P = 0.72). The complete response rate was 86% (n = 19) among BP (FIGO stage I; n = 9, II; n = 4, III; n = 4, IVA; n = 2) versus 59% (n = 10) among WP (I; n = 1, II; n = 1, III; n = 6, IVA; n = 2), (P = 0.51). One-year estimated LRC, PFS and OS were 100% versus 66% (P = 0.001), 100% versus 50% (P < 0.001) and 95% versus 70% (P = 0.04) for BP versus WP, respectively. On univariate analysis, only complete response to treatment (P < 0.001) and race were significantly associated with LRC and survival.Conclusion: This data demonstrates high response rates and local control for early stage VSCC, which primarily included BP in this cohort. Further exploration is needed to understand the etiology behind these differences. These data suggest a potential role for therapeutic stratification to optimize outcomes and decrease late toxicity.Author Disclosure: J.S. Remick: None. N.S. McCall: Honoraria; PrecisCA.N. Khanna: None. J.W. Shelton: None. S. Hanasoge: None. P.R. Patel: None. A.B. Patel: Honoraria; American College of Radiology. T. Cole: None. A. McCook: None. A.N. Gordon: None. C. Han: None. K. Starbuck: None. J. Switchenko: None. T.Y. Eng: Stock; Amgen. [ABSTRACT FROM AUTHOR]