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.

This retrospective cohort study asked whether prophylactic extended-field irradiation (EFI) improves para-aortic control and survival compared with pelvic radiotherapy alone in high-risk locally advanced cervical cancer patients with radiologically negative para-aortic lymph nodes. Among 293 patients, EFI was associated with markedly lower para-aortic recurrence (2.1% vs 11.1%) and better 5-year PFS (70.9% vs 58.8%) and DMFS (83.7% vs 75.2%), with only more frequent grade 3-4 leukopenia as a notable toxicity. Although the overall survival difference did not reach statistical significance (79.1% vs 68.6%, P = 0.052), the findings support evaluating a risk-adapted approach to selecting patients for prophylactic EFI.