Concomitant chemoradiotherapy is the usual treatment for locally advanced cervical cancer. Pelvic irradiation is usually advised for patients with negative para-aortic lymph nodes (PALNs). However, owing to the emergence of imaging-guided brachytherapy, distant failure has become the main failure pattern. The PALNs is a crucial site of distant metastases, and the para-aortic region may include concealed microscopic metastases that were scarcely discovered owing to imaging technology restrictions. The prognosis of patients who had sustained PALN failure was bleak. Typically, there are 4 approaches to decreasing PALN failure. First, surgical staging can be conducted to assess the occurrence of metastases in the para-aortic area; however, the application of surgical staging is decreasing owing to questionable survival advantages and concomitant hazards of surgery. Second, routine imaging surveillance and quick salvage of early recurrences could reduce PALN failure. Third, improved systemic adjuvant therapy could be advised since it has significant potential to reduce distant metastases and enhance overall survival. Fourth, administering prophylactic extended-field irradiation (EFI), comprising pelvic and para-aortic region irradiation, can sterilize occult microscopic metastases in the para-aortic region and increase survival. Prior investigations have indicated that prophylactic EFI could lessen PALN failure and distant metastases and provide the benefit of survival. Yet, owing to the substantial morbidity generated by extended irradiation fields in the era of conventional irradiation techniques, further research on EFI remains stagnant. With new technologies, intensity-modulated radiation treatment may provide a larger dosage for malignancies with acceptable toxicity. Prophylactic EFI regained interest. However, the inclusion criteria of prophylactic EFI in existing trials reveal substantial variations. Thus, it is vital to clearly identify indications for higher survival and lower comorbidities in individuals with cervical cancer. In this analysis, researchers highlight indications and brief guidelines for prophylactic EFI, which may offer a framework for subsequent research and clinical applications.
Source: sciencedirect.com/science/article/pii/S0090825822004814
