A 33-year review from the University of Michigan Medical Center of 86 cases of primary carcinoma of the vagina included 68 squamous carcinomas, 13 adenocarcinomas, and 5 small cell carcinomas. There was a 26% incidence of prior cervical carcinoma and a 21% incidence of prior pelvic radiation therapy. The median interval between the diagnosis of invasive cervical and vaginal carcinoma was 20 years. Survival was strongly correlated with stage. There was no association between survival and involvement of a particular vaginal segment or the amount of vaginal surface area involved with tumor. Irradiation was the most frequently employed primary therapy for vaginal carcinoma. Local control was correlated with the mid-tumor irradiation dose, with predictable control obtained only with doses above 7500 rad. The use of interstitial therapy should facilitate local control without increasing the complication rate.