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PubMed\/MEDLINE, Cochrane, and Ichushi were searched on July 29, 2025, using \u201ccervical cancer,\u201d \u201cintermediate-risk,\u201d and \u201cadjuvant therapy.\u201d Studies comparing adjuvant radiotherapy alone (RT) with no further treatment (NFT), concurrent chemoradiotherapy (CCRT), or systemic chemotherapy (CT) after conventional radical hysterectomy were independently reviewed by two reviewers. Primary outcomes were survival and grade\u2009\u2265\u20093 treatment-related toxicities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 402 screened articles, 24 studies comprising 9278 patients were included: RT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094167), NFT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092057), CCRT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092118), and CT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009936). The majority of studies enrolled patients with\u2009\u2265\u20092 Sedlis risk factors (median 84.2%, interquartile range 44.7\u2013100%). Compared with NFT, RT significantly improved recurrence-free survival (HR 0.61,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) but did not confer a significant overall survival benefit (HR 0.77,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.09). RT also reduced recurrence in patients with a single risk factor (HR 0.55,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). RT showed no survival disadvantage compared with CCRT (recurrence-free survival: HR 1.26; overall survival: HR 1.07), and survival outcomes were comparable between RT and CT (recurrence-free survival: HR 0.86; overall survival: HR 1.16) (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). Grade\u2009\u2265\u20093 toxicities were significantly lower with RT than with CCRT (odds ratio 0.25;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjuvant RT represents an effective and well-tolerated postoperative strategy for intermediate-risk, early-stage cervical cancer. Adjuvant CT may represent a potential alternative option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-026-03028-9","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T06:34:19Z","timestamp":1776753259000},"page":"1084-1095","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimal adjuvant strategy in intermediate-risk cervical cancer: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"31","author":[{"given":"Akira","family":"Yokoi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2252-3577","authenticated-orcid":false,"given":"Hiroko","family":"Machida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Okazawa-Sakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Nishino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanae","family":"Sekine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mizue","family":"Itoi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Mitamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiaki","family":"Isohashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Tsuchida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruya","family":"Saji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoe","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Ii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadaaki","family":"Nishikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiko","family":"Kodama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Takehara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohru","family":"Morisada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-ei","family":"Noda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munetaka","family":"Takekuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Kajiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Tokunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsukasa","family":"Baba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichi","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikou","family":"Okamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"3","key":"3028_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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All the other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Required for this systematic review with meta-analysis, as all data had already been published in peer-reviewed journals. No patients were involved in the design, conduct, or interpretation of our study.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":3,"name":"Ethics","label":"Declaration of generative AI and AI-assisted technologies in the manuscript","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Registration number: 1186079 registration date: 7 November 2025.","order":4,"name":"Ethics","label":"Clinical trail registry","group":{"name":"EthicsHeading","label":"Declarations"}}]}}