Comparative Analysis of Oncologic Outcomes in Patients with Squamous Cell Carcinoma of the Uterine Cervix with High-Risk Features for Para-Aortic Recurrence: Prophylactic Extended-Field versus Pelvic Chemoradiotherapy

Purpose: To compare the oncologic outcomes of prophylactic extended-field radiation therapy (EFRT) and whole pelvic radiation therapy (WPRT) in cervical patients at high risk of para-aortic lymph node (PALN) recurrence.Patients and Methods: From July 1999 to May 2022, a total of 115 patients with cervical cancer and high-risk features of PALN recurrence based on tumor markers, positive LNs and extensive parametrial invasion were retrospectively analyzed.All patients had received EFRT or WPRT at a dose of 39.6-45 Gy and concurrent chemotherapy.In EFRT, coverage was extended to include the paraaortic region below the level of the left renal vein or T12.Results: Twenty-eight and 87 patients underwent EFRT and WPRT, respectively.For patients who survived, the median follow-up time was 60.8 months (range 9.2-131.6months) in the EFRT group and 115.9 months (range 16.9-212.1months) in the WPRT group.The 5-year overall survival (OS) and pelvic, extrapelvic and PALN recurrence rates were 87.7% vs 60.8% (p=0.019),10.9% vs 25.3% (p=0.119),18.1% vs 45.8% (p=0.011), and 0% vs 30.4% (p=0.005),respectively, between the EFRT and WPRT groups.Multivariate analysis revealed that EFRT and 2018 FIGO stage IV disease status were significant predictors of OS and extrapelvic recurrence.Conclusion: Compared to WPRT, EFRT significantly improved OS and reduced extrapelvic and PALN recurrence in patients with cervical cancer with high-risk recurrence features.