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Prophylactic extended-field radiotherapy with concurrent chemotherapy for locally advanced cervical cancer: a
Objective:
The study aimed to evaluate the efficacy of prophylactic para-aortic extended-field radiotherapy in participants with locally advanced cervical cancer undergoing concurrent chemoradiotherapy.
Methods:
This retrospective study included eligible participants with cervical cancer diagnosed with 2009 International Federation of Gynecology and Obstetrics stage IB to ⅣA and negative common iliac and para-aortic lymph nodes. All patients received concurrent chemotherapy with either pelvic or extended-field radiotherapy from March 2007 to December 2022. Propensity-score matching was used to balance key variables.
Results:
Of the 1547 participants included, 1265 received pelvic radiotherapy and 282 received extended-field radiotherapy. Participants who received extended-field radiotherapy were more likely to have advanced disease, large tumor size, or pelvic lymph node involvement. Propensity-score matching resulted in 2 well-matched cohorts of 247 participants each, with balanced key variables. With a median follow-up of 69.0 months, extended-field radiotherapy was associated with a reduced risk of 5-year para-aortic lymph node failure relative to pelvic radiotherapy (2.5% vs 8.4%, p = .005). However, this local control benefit did not translate into significant improvements in survival outcomes. Five-year disease-free survival (71.4% vs 73.6%, p = .701) and overall survival (85.4% vs 80.8%, p = .183) remained comparable between extended-field radiotherapy and pelvic radiotherapy, as did the distant failure rate (22.0% vs 17.1%, p = .154). Multi-variate analysis revealed that extended-field radiotherapy was associated with better para-aortic lymph node control (hazard ratio 0.32, 95% confidence interval 0.15 to 0.70, p = .005). The incidence of grade 3 to 4 hematologic toxicities was higher in the extended-field radiotherapy group, whereas acute and chronic gastrointestinal and genitourinary toxicities were comparable.
Conclusions:
The largest retrospective study demonstrated that prophylactic extended-field radiotherapy was well tolerated and improved para-aortic lymph node control, though it did not confer a significant survival benefit. Further prospective trials are warranted to establish the role of risk-adapted strategies.
