We retrospectively reviewed local failure for vaginal carcinoma in patients treated with curative intent with comparison of various boost techniques following external beam pelvic irradiation. Between 1972 and 1998, a total of 27 patients were treated for primary vaginal carcinoma; 19 patients were evaluable. There were two patients with stage I disease, 11 stage II, and six stage III. Patients with stage I disease were treated with intracavitary brachytherapy alone. Patients with stage II/III disease received external pelvic irradiation followed by intracavitary brachytherapy for superficial residual tumor measuring less than 0.5 cm in thickness or interstitial implant for bulky residual tumor. Data were reviewed to identify first sites of failure and radiotherapy techniques. There were four local recurrences in 17 evaluable patients who completed therapy for a local failure rate of 24% (two patients who did not complete treatment were excluded from analysis). No local recurrences were reported in the patients with stage I disease, both of whom were treated using vaginal cylinder alone. For stage II/III disease, there were two local recurrences in five patients boosted with a vaginal cylinder (40%), one local recurrence in four patients treated with the shrinking field technique for boost (25%), and one local recurrence in the six patients boosted with an interstitial implant (16%). Due to depth dose limitations, the use of intracavitary brachytherapy for boost in stage II/III disease should be limited, even with favorable tumor shrinkage by external pelvic irradiation.