Prophylactic extended-field radiotherapy with concurrent chemotherapy for locally advanced cervical cancer: a propensity-score matching analysis.

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.