Prophylactic extended-field irradiation versus pelvic radiotherapy in high-risk locally advanced cervical cancer with radiologically negative para-aortic lymph nodes: a retrospective cohort study
In brief
Extended-field radiation linked to 2.1% recurrence vs 11.1% in high-risk cervical cancer
In this retrospective cohort, para-aortic recurrence was 2.1% with extended-field radiation and 11.1% with pelvic radiation among patients with high-risk cervical cancer and no visible para-aortic disease. Five-year progression-free and distant metastasis-free survival were also higher, but overall survival was not significantly different. Severe leukopenia was more frequent with extended-field treatment, and randomized studies are needed to confirm the benefit.
- Journal
- Gynecologic oncology (Q1)
- Published
- 6 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Hao Shao, Yangzhi Zhao, Ting Cui, Tiejun Wang, Zhongshan Liu
- PMID
- 42994080
- DOI
- 10.1016/j.ygyno.2026.10.033
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (paper of the day, 9 November 2026): Compares radiotherapy fields and outcomes in locally advanced cervical cancer
Abstract
OBJECTIVE: To compare para-aortic recurrence, survival outcomes, and treatment-related toxicity between prophylactic extended-field irradiation (EFI) and pelvic radiotherapy (PRT) in patients with high-risk locally advanced cervical cancer (LACC) who have radiologically negative para-aortic lymph nodes (PALNs). METHODS: We retrospectively reviewed patients with FIGO 2018 stage III-IVA cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy between December 2015 and December 2022. Eligible patients had radiologically negative PALNs and at least one high-risk feature: ≥2 positive pelvic lymph nodes, a maximum pelvic nodal short-axis diameter ≥ 1.5 cm, or pelvic sidewall involvement. Patients received EFI (n = 140) or PRT (n = 153). Survival outcomes were compared using Kaplan-Meier analysis and Cox regression. RESULTS: Para-aortic recurrence occurred in 2.1% of patients receiving EFI and 11.1% receiving PRT. Five-year PARFS, PFS, and DMFS were higher with EFI than with PRT (97.8% vs 88.1%, P = 0.002; 70.9% vs 58.8%, P = 0.002; and 83.7% vs 75.2%, P = 0.032, respectively). Five-year OS was 79.1% versus 68.6% (P = 0.052). In multivariable analysis, EFI remained associated with improved PFS (HR, 0.532; P = 0.002), DMFS (HR, 0.554; P = 0.036), and PARFS (HR, 0.178; P = 0.006), but not OS (HR, 0.630; P = 0.054). Grade 3-4 leukopenia was more frequent with EFI, whereas other severe toxicities were similar. CONCLUSIONS: Prophylactic EFI was associated with improved para-aortic control, PFS, and DMFS in high-risk LACC, with acceptable toxicity. These findings support further evaluation of a risk-adapted strategy for selecting patients who may benefit from prophylactic EFI.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.