KEY POINTS
- This single-centre retrospective study included 97 patients with cervical cancer and imaging-defined para-aortic nodal metastases treated with definitive extended-field radiotherapy between 2011 and 2023. Median follow-up was 34 months.
- Median doses were 56 Gy to involved nodes and 50 Gy to elective regions; 90 patients (93%) received concurrent platinum-based chemotherapy. The elective margin above the uppermost involved para-aortic node was one vertebral height or less in 66 patients (68%).
- Three-year in-field recurrence-free survival, distant metastasis-free survival, and overall survival were 74.0%, 50.7%, and 66.2%, respectively. Distant metastasis occurred in 37 of 53 patients with recurrence.
- A gross nodal-to-primary tumor volume ratio of at least 15% was associated with lower three-year distant metastasis-free survival: 39.7% versus 59.1% for ratios below 15% (p=0.02). The continuous ratio remained significant on multivariable analysis (p=0.02; 95% confidence interval 1.01–1.121).
- Only two patients (2.1%) developed isolated para-aortic recurrence outside the treated field. Treatment-related grade 3 acute toxicity occurred in five patients, and late grade 3 toxicity occurred in eight; no grade 4 or higher late adverse events were reported.
CLINICAL TAKEAWAY
The nodal-to-primary tumor volume ratio may help identify patients with para-aortic node-positive cervical cancer who are at particularly high risk of distant failure and may warrant consideration for systemic treatment intensification. The low rate of isolated out-of-field para-aortic recurrence also questions the need for generous superior margins, but both findings require prospective validation before changing treatment selection or field design.