{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:53:46Z","timestamp":1790862826742,"version":"4.1.0"},"reference-count":15,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:00:00Z","timestamp":1735084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Guidelines recommend the extension of the pelvic radiotherapy volume to the para-aortic region in locally advanced cervical cancer and \u22653 suspicious pelvic lymph nodes (PLN) on imaging. Whether this recommendation is also valid for clinically early stages is uncertain. The objective of this study was to investigate the para-aortic (PAO) lymph node recurrence rate in patients with early-stage cervical cancer, \u22653 metastatic PLN, and negative common iliac nodes after a radical hysterectomy followed by pelvic (chemo)radiotherapy without extension to the PAO region. Methods: Consecutive patients, surgically treated between 2000 and 2020, with FIGO 2009 stage IB2-IIA1 and positive PLN, were included in this retrospective cohort study. The frequency of PAO recurrences, disease-free survival, and overall survival were analyzed in patients with &lt;3 versus \u22653 positive PLN. Results: In 127 patients, the isolated PAO recurrence rate was 2\/88 (2.3%) versus 1\/39 (2.6%) for patients with &lt;3 versus \u22653 positive PLNs, respectively (p = 0.671). The 5-year disease-free survival (87.3% versus 73.7%; p = 0.088) and the overall survival (90.7% versus 76.5%; p = 0.355) between patients with &lt;3 versus \u22653 positive PLN was not significantly different. Conclusions: Isolated PAO nodal recurrence rate in women with early-stage cervical cancer after radical hysterectomy and pelvic lymphadenectomy, with positive PLN but negative common iliac nodes, followed by pelvic (chemo)radiotherapy, is low and did not differ between the groups with &lt;3 versus \u22653 positive PLN. This makes it unlikely that the inclusion of the PAO region in the adjuvant radiotherapy volume would result in a better oncological outcome.<\/jats:p>","DOI":"10.3390\/cancers17010023","type":"journal-article","created":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T19:27:46Z","timestamp":1735154866000},"page":"23","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of the Number of Positive Pelvic Lymph Nodes on Risk of Para-Aortic Recurrence in Patients with Clinically Early Cervical Cancer Treated by a Radical Hysterectomy and Pelvic Lymphadenectomy"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1773-8805","authenticated-orcid":false,"given":"Felix J. M.","family":"Schoonhoven","sequence":"first","affiliation":[{"name":"Department of Gynecological Oncology, Centre for Gynecologic Oncology Amsterdam (C.G.O.A.), Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0674-9405","authenticated-orcid":false,"given":"Johanna W. M.","family":"Aarts","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Centre for Gynecologic Oncology Amsterdam (C.G.O.A.), Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guus","family":"Fons","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Centre for Gynecologic Oncology Amsterdam (C.G.O.A.), Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas J. A.","family":"Stalpers","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Amsterdam University Medical Center, 1055 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6905-2704","authenticated-orcid":false,"given":"Luc R. C. W.","family":"van Lonkhuijzen","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Centre for Gynecologic Oncology Amsterdam (C.G.O.A.), Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5985-1163","authenticated-orcid":false,"given":"Jacobus","family":"van der Velden","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Centre for Gynecologic Oncology Amsterdam (C.G.O.A.), Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2838-2031","authenticated-orcid":false,"given":"Constantijne H.","family":"Mom","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Centre for Gynecologic Oncology Amsterdam (C.G.O.A.), Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S2214-109X(22)00501-0","article-title":"Global estimates of incidence and mortality of cervical cancer in 2020: A baseline analysis of the WHO Global Cervical Cancer Elimination Initiative","volume":"11","author":"Singh","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1007\/s10147-021-01980-2","article-title":"The role of lymph nodes in cervical cancer: Incidence and identification of lymph node metastases\u2014A literature review","volume":"26","author":"Olthof","year":"2021","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/ijgc-2023-004429","article-title":"SGO\/ESTRO\/ESP Guidelines for the management of patients with cervical cancer-Update 2023","volume":"33","author":"Cibula","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ejogrb.2020.08.020","article-title":"British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice","volume":"256","author":"Reed","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_5","unstructured":"NCCN (2024, May 01). Guidelines Version 1.2024 Cervical Cancer. Available online: https:\/\/www.nccn.org\/login?ReturnURL=https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/cervical.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.3802\/jgo.2024.35.e15","article-title":"Japan Society of Gynecologic Oncology 2022 guidelines for uterine cervical neoplasm treatment","volume":"35","author":"Seino","year":"2024","journal-title":"J. Gynecol. Oncol."},{"key":"ref_7","first-page":"48","article-title":"The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies","volume":"9","author":"Tanderup","year":"2018","journal-title":"Clin. Transl. Radiat. 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Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ygyno.2009.09.003","article-title":"Pelvic lymphadenectomy in cervical cancer\u2014Surgical anatomy and proposal for a new classification system","volume":"116","author":"Cibula","year":"2010","journal-title":"Gynecol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.3802\/jgo.2018.29.e10","article-title":"Quality and quantity metrics of pelvic lymph node metastasis and risk of para-aortic lymph node metastasis in stage IB\u2013IIB cervical cancer","volume":"29","author":"Matsuo","year":"2018","journal-title":"J. Gynecol. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ygyno.2023.01.031","article-title":"Isolated para-aortic nodal recurrence after treatment of early stage cervical carcinoma","volume":"170","author":"Holloway","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ejca.2021.09.008","article-title":"The annual recurrence risk model for tailored surveillance strategy in cervical cancer patients","volume":"158","author":"Cibula","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1136\/ijgc-2019-000669","article-title":"Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer","volume":"29","author":"Bogani","year":"2019","journal-title":"Int. J. Gynecol. Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/1\/23\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:59:56Z","timestamp":1760115596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/1\/23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,25]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["cancers17010023"],"URL":"https:\/\/doi.org\/10.3390\/cancers17010023","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,25]]}}}