Prophylactic extended-field radiotherapy with concurrent chemotherapy for locally advanced cervical cancer: A Propensity-Score Matching Analysis

ObjectiveThe study aimed to evaluate the efficacy of prophylactic para-aortic extended-field radiotherapy in locally advanced cervical cancer undergoing concurrent chemoradiotherapy. Methods Thisretrospective study included eligible participants with cervical cancer diagnosed with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage I B-A 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. ResultsOf 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 two 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 = 0.005).However, this local control benefit did not translate into significant improvements in survival outcomes.5-year disease-free survival (71.4% vs. 73.6%,P = 0.701) and overall survival (85.4% vs. 80.8%,P = 0.183) remained comparable between extended-field