{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:45:29Z","timestamp":1787240729921,"version":"build-2736575974"},"reference-count":165,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"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>Approximately 36% of patients with cervical cancer present with regional nodal metastasis at diagnosis, which is associated with adverse survival outcomes after definitive treatment. In the modern era of chemoradiotherapy (CRT) and image-guided adaptive brachytherapy (IGABT), where excellent local control is achieved for patients with locally advanced cervical cancer (LACC), nodal failure remains a major challenge to cure. To optimize treatment outcomes for node-positive LACC and reduce the incidence of nodal failure, various treatment approaches have been explored, including methods of surgical nodal staging or dissection, RT dose escalation strategies, such as intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to involved nodes, and elective treatment of subclinical para-aortic (PAO) disease. Additionally, there is growing interest in emerging precision RT techniques, such as magnetic resonance-guided radiotherapy (MRgRT) and proton therapy, which may allow for further improvement in the therapeutic ratio. This review outlines the various methods of detection of nodal metastasis, treatment options for node-positive LACC, techniques of nodal radiotherapy and their clinical evidence in efficacy and toxicity profiles. Furthermore, recent advances in systemic therapy and promising novel therapeutic directions that may shape the management of node-positive LACC are discussed.<\/jats:p>","DOI":"10.3390\/cancers17020202","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T09:54:27Z","timestamp":1736416467000},"page":"202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Current Paradigm and Future Directions in the Management of Nodal Disease in Locally Advanced Cervical Cancer"],"prefix":"10.3390","volume":"17","author":[{"given":"Elki Sze-Nga","family":"Cheung","sequence":"first","affiliation":[{"name":"Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5106-4087","authenticated-orcid":false,"given":"Philip Yuguang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1136\/ijgc-2022-003801","article-title":"Proportions and Incidence of Locally Advanced Cervical Cancer: A Global Systematic Literature Review","volume":"32","author":"Monk","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.radonc.2016.03.011","article-title":"Image Guided Brachytherapy in Locally Advanced Cervical Cancer: Improved Pelvic Control and Survival in RetroEMBRACE, a Multicenter Cohort Study","volume":"120","author":"Sturdza","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.ygyno.2014.08.027","article-title":"Improved Survival of Patients with Cervical Cancer Treated with Image-Guided Brachytherapy Compared with Conventional Brachytherapy","volume":"135","author":"Rijkmans","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.radonc.2011.07.012","article-title":"Clinical Outcome of Protocol Based Image (MRI) Guided Adaptive Brachytherapy Combined with 3D Conformal Radiotherapy with or without Chemotherapy in Patients with Locally Advanced Cervical Cancer","volume":"100","author":"Georg","year":"2011","journal-title":"Radiother. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.brachy.2018.11.007","article-title":"MRI-Guided Adaptive Brachytherapy for Locally Advanced Cervix Cancer: Treatment Outcomes from a Single Institution in Hong Kong","volume":"18","author":"Wu","year":"2019","journal-title":"Brachytherapy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.ijrobp.2019.03.038","article-title":"Change in Patterns of Failure After Image-Guided Brachytherapy for Cervical Cancer: Analysis From the RetroEMBRACE Study","volume":"104","author":"Tan","year":"2019","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.radonc.2019.02.007","article-title":"Nodal Failure after Chemo-Radiation and MRI Guided Brachytherapy in Cervical Cancer: Patterns of Failure in the EMBRACE Study Cohort","volume":"134","author":"Nomden","year":"2019","journal-title":"Radiother. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cheung, E.S.-N., Law, F.C.-H., Fung, N.T.-C., Soong, I.S., Hung, R.H.-M., Tse, T.K.-H., Wong, K.K.-S., and Wu, P.Y. (2023). Simultaneous Integrated Boost for Dose Escalation in Node-Positive Cervical Cancer: 5-Year Experience in a Single Institution. Cancers, 15.","DOI":"10.3390\/cancers15184647"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.radonc.2017.01.015","article-title":"Clinical Implementation of Coverage Probability Planning for Nodal Boosting in Locally Advanced Cervical Cancer","volume":"123","author":"Ramlov","year":"2017","journal-title":"Radiother. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.ijrobp.2014.08.013","article-title":"Extended Field Intensity Modulated Radiation Therapy with Concomitant Boost for Lymph Node\u2013Positive Cervical Cancer: Analysis of Regional Control and Recurrence Patterns in the Positron Emission Tomography\/Computed Tomography Era","volume":"90","author":"Vargo","year":"2014","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.7150\/jca.29301","article-title":"Efficacy and Toxicity of IMRT-Based Simultaneous Integrated Boost for the Definitive Management of Positive Lymph Nodes in Patients with Cervical Cancer","volume":"10","author":"Dang","year":"2019","journal-title":"J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e625","DOI":"10.1016\/j.ijrobp.2018.07.1710","article-title":"Lymph Node-Directed Simultaneous Integrated Boost in Patients with Clinically Lymph Node-Positive Cervical Cancer Treated with Definitive Chemoradiation: Clinical Outcomes and Toxicity","volume":"102","author":"Jethwa","year":"2018","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13014-021-01818-1","article-title":"High Dose Simultaneous Integrated Boost for Node Positive Cervical Cancer","volume":"16","author":"Jayatilakebanda","year":"2021","journal-title":"Radiat. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ygyno.2021.07.023","article-title":"Impact of Nodal Boost Irradiation and MR-Based Brachytherapy on Oncologic Outcomes in Node-Positive Cervical Cancer","volume":"163","author":"Tiwari","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ygyno.2017.04.016","article-title":"Prophylactic Lower Para-Aortic Irradiation Using Intensity-Modulated Radiotherapy Mitigates the Risk of Para-Aortic Recurrence in Locally Advanced Cervical Cancer: A 10-Year Institutional Experience","volume":"146","author":"Lee","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1080\/0284186X.2017.1349335","article-title":"Early Clinical Outcome of Coverage Probability Based Treatment Planning for Simultaneous Integrated Boost of Nodes in Locally Advanced Cervical Cancer","volume":"56","author":"Lindegaard","year":"2017","journal-title":"Acta Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/S0140-6736(24)01438-7","article-title":"Induction Chemotherapy Followed by Standard Chemoradiotherapy versus Standard Chemoradiotherapy Alone in Patients with Locally Advanced Cervical Cancer (GCIG INTERLACE): An International, Multicentre, Randomised Phase 3 Trial","volume":"404","author":"McCormack","year":"2024","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1016\/S0140-6736(24)01808-7","article-title":"Pembrolizumab or Placebo with Chemoradiotherapy Followed by Pembrolizumab or Placebo for Newly Diagnosed, High-Risk, Locally Advanced Cervical Cancer (ENGOT-Cx11\/GOG-3047\/KEYNOTE-A18): Overall Survival Results from a Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial","volume":"404","author":"Lorusso","year":"2024","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ygyno.2021.08.026","article-title":"From FIGO-2009 to FIGO-2018 in Women with Early-Stage Cervical Cancer; Does the Revised Staging Reflect Risk Groups?","volume":"163","author":"Sponholtz","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"FIGO Committee on Gynecologic Oncology (2014). FIGO Staging for Carcinoma of the Vulva, Cervix, and Corpus Uteri. Int. J. Gynecol. Obstet., 125, 97\u201398.","DOI":"10.1016\/j.ijgo.2014.02.003"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.2214\/ajr.180.6.1801621","article-title":"Diagnosis, Staging, and Surveillance of Cervical Carcinoma","volume":"180","author":"Kaur","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1006\/gyno.1995.1261","article-title":"Surgical Predictors of Para-Aortic Metastases in Early-Stage Cervical Carcinoma","volume":"59","author":"Hackett","year":"1995","journal-title":"Gynecol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1634\/theoncologist.2011-0007","article-title":"Analysis of Morbidity and Clinical Implications of Laparoscopic Para-Aortic Lymphadenectomy in a Continuous Series of 98 Patients with Advanced-Stage Cervical Cancer and Negative PET\u2013CT Imaging in the Para-Aortic Area","volume":"16","author":"Uzan","year":"2011","journal-title":"Oncologist"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.3109\/0284186X.2015.1061693","article-title":"Impact of Radiation Dose and Standardized Uptake Value of (18)FDG PET on Nodal Control in Locally Advanced Cervical Cancer","volume":"54","author":"Ramlov","year":"2015","journal-title":"Acta Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/ijgo.12749","article-title":"Revised FIGO Staging for Carcinoma of the Cervix Uteri","volume":"145","author":"Bhatla","year":"2019","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1097\/IGC.0b013e31829783c4","article-title":"Lacunae in International Federation of Gynecology and Obstetrics (FIGO) Classification for Cervical Carcinoma: Observational Study Using TNM Classification as Comparator","volume":"23","author":"Meva","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_27","first-page":"215","article-title":"Stage IB Carcinoma of the Cervix, the Norwegian Radium Hospital. II. Results When Pelvic Nodes Are Involved","volume":"60","author":"Martimbeau","year":"1982","journal-title":"Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1002\/1097-0142(19910601)67:11<2776::AID-CNCR2820671111>3.0.CO;2-L","article-title":"Carcinoma of the Cervix Treated with Radiation Therapy I. A Multi-Variate Analysis of Prognostic Variables in the Gynecologic Oncology Group","volume":"67","author":"Stehman","year":"1991","journal-title":"Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/1477-7819-2-47","article-title":"The Prognosis of Women with Stage IB1-IIB Node-Positive Cervical Carcinoma after Radical Surgery","volume":"2","author":"Cheng","year":"2004","journal-title":"World J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/AOG.0000000000003311","article-title":"Prognostic Performance of the 2018 International Federation of Gynecology and Obstetrics Cervical Cancer Staging Guidelines","volume":"134","author":"Wright","year":"2019","journal-title":"Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.ygyno.2020.03.027","article-title":"FIGO 2018 Staging Criteria for Cervical Cancer: Impact on Stage Migration and Survival","volume":"157","author":"Grigsby","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1038\/sj.bjc.6605801","article-title":"The Impact of Lymph Node Density on Survival of Cervical Cancer Patients","volume":"103","author":"Polterauer","year":"2010","journal-title":"Br. J. Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"964","DOI":"10.4143\/crt.2017.346","article-title":"The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)","volume":"50","author":"Kwon","year":"2018","journal-title":"Cancer Res. Treat."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/aogs.14316","article-title":"The Prognostic Value of the Number of Positive Lymph Nodes and the Lymph Node Ratio in Early-stage Cervical Cancer","volume":"101","author":"Olthof","year":"2022","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ygyno.2018.10.026","article-title":"Validation of the 2018 FIGO Cervical Cancer Staging System","volume":"152","author":"Matsuo","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1148\/rg.2020200013","article-title":"2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging","volume":"40","author":"Salib","year":"2020","journal-title":"RadioGraphics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/j.1349-7006.2010.01532.x","article-title":"Diagnostic Performance of Computer Tomography, Magnetic Resonance Imaging, and Positron Emission Tomography or Positron Emission Tomography\/Computer Tomography for Detection of Metastatic Lymph Nodes in Patients with Cervical Cancer: Meta-analysis","volume":"101","author":"Choi","year":"2010","journal-title":"Cancer Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"14107","DOI":"10.18632\/oncotarget.12959","article-title":"Different Imaging Techniques for the Detection of Pelvic Lymph Nodes Metastasis from Gynecological Malignancies: A Systematic Review and Meta-Analysis","volume":"8","author":"Gong","year":"2017","journal-title":"Oncotarget"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.critrevonc.2019.03.008","article-title":"Positron Emission Tomography with Computed Tomography Imaging (PET\/CT) for the Radiotherapy Planning Definition of the Biological Target Volume: PART 2","volume":"139","author":"Fiorentino","year":"2019","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1148\/radiology.218.3.r01mr19776","article-title":"Metastatic Lymph Nodes in Patients with Cervical Cancer: Detection with MR Imaging and FDG PET","volume":"218","author":"Reinhardt","year":"2001","journal-title":"Radiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1136\/ijgc-00009577-200107000-00002","article-title":"A Comparison of MRI and PET Scanning in Surgically Staged Loco-Regionally Advanced Cervical Cancer: Potential Impact on Treatment","volume":"11","author":"Narayan","year":"2001","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s13244-023-01589-1","article-title":"Diagnostic Accuracy of MRI, CT, and [18F]FDG-PET-CT in Detecting Lymph Node Metastases in Clinically Early-Stage Cervical Cancer\u2014A Nationwide Dutch Cohort Study","volume":"15","author":"Olthof","year":"2024","journal-title":"Insights Imaging"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.ygyno.2008.03.018","article-title":"Positron Emission Tomography in Evaluating the Feasibility of Curative Intent in Cervical Cancer Patients with Limited Distant Lymph Node Metastases","volume":"110","author":"Chao","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1006\/gyno.2002.6769","article-title":"Contribution of Whole-Body 18FDG PET Imaging in the Management of Cervical Cancer","volume":"87","author":"Belhocine","year":"2002","journal-title":"Gynecol. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1136\/ijgc-2023-004523","article-title":"ESGO\/ESTRO\/ESP Updated Guidelines in Cervical Cancer","volume":"33","author":"Ramirez","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e212","DOI":"10.1016\/S1470-2045(12)70011-6","article-title":"Nodal-Staging Surgery for Locally Advanced Cervical Cancer in the Era of PET","volume":"13","author":"Gouy","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1002\/cncr.23400","article-title":"Surgical versus Radiographic Determination of Para-aortic Lymph Node Metastases before Chemoradiation for Locally Advanced Cervical Carcinoma: A Gynecologic Oncology Group Study","volume":"112","author":"Gold","year":"2008","journal-title":"Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S0090-8258(03)00064-7","article-title":"Randomized Trial of Surgical Staging (Extraperitoneal or Laparoscopic) versus Clinical Staging in Locally Advanced Cervical Cancer","volume":"89","author":"Lai","year":"2003","journal-title":"Gynecol. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3026","DOI":"10.1200\/JCO.2012.47.3520","article-title":"Prospective Multicenter Study Evaluating the Survival of Patients with Locally Advanced Cervical Cancer Undergoing Laparoscopic Para-Aortic Lymphadenectomy Before Chemoradiotherapy in the Era of Positron Emission Tomography Imaging","volume":"31","author":"Gouy","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1136\/ijgc-2020-001973","article-title":"Surgical versus Clinical Staging Prior to Primary Chemoradiation in Patients with Cervical Cancer FIGO Stages IIB\u2013IVA: Oncologic Results of a Prospective Randomized International Multicenter (Uterus-11) Intergroup Study","volume":"30","author":"Marnitz","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/0090-8258(86)90028-4","article-title":"The Influence of Surgical Staging on the Evaluation and Treatment of Patients with Cervical Carcinoma","volume":"24","author":"LaPolla","year":"1986","journal-title":"Gynecol. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.gmit.2016.01.003","article-title":"Laparoscopic Technique of Para-Aortic Lymph Node Dissection: A Comparison of the Different Approaches to Trans- versus Extraperitoneal Para-Aortic Lymphadenectomy","volume":"6","author":"Kusunoki","year":"2017","journal-title":"Gynecol. Minim. Invasive Ther."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4677","DOI":"10.21873\/anticanres.12773","article-title":"Transperitoneal Versus Extraperitoneal Laparoscopic Lymphadenectomy for Gynecological Malignancies: A Systematic Review and Meta-Analysis","volume":"38","author":"Prodromidou","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ejogrb.2019.02.033","article-title":"Para-Aortic plus Pelvic Lymphadenectomy in Locally Advanced Cervical Cancer: A Single Institutional Experience","volume":"236","author":"Mezquita","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_55","first-page":"e1","article-title":"Perioperative Morbidity and Rate of Upstaging after Laparoscopic Staging for Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial","volume":"213","author":"Mustea","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.ygyno.2006.12.012","article-title":"Therapeutic Value of Pretherapeutic Extraperitoneal Laparoscopic Staging of Locally Advanced Cervical Carcinoma","volume":"105","author":"Leblanc","year":"2007","journal-title":"Gynecol. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jmig.2021.06.027","article-title":"Laparoscopic Debulking of Enlarged Pelvic Nodes during Surgical Para-Aortic Staging in Locally Advanced Cervical Cancer: A Retrospective Comparative Cohort Study","volume":"29","author":"Acosta","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ygyno.2013.11.004","article-title":"Comparison of Robotic-Assisted vs Conventional Laparoscopy for Extraperitoneal Paraaortic Lymphadenectomy","volume":"132","author":"Magrina","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1006\/gyno.2001.6528","article-title":"Evaluation of Patients after Extraperitoneal Lymph Node Dissection and Subsequent Radiotherapy for Cervical Cancer","volume":"84","author":"Hasenburg","year":"2002","journal-title":"Gynecol. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e291","DOI":"10.1016\/j.prro.2014.10.013","article-title":"Extended Field Intensity Modulated Radiation Therapy for Gynecologic Cancers: Is the Risk of Duodenal Toxicity High?","volume":"5","author":"Xu","year":"2015","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1016\/j.ijrobp.2012.10.004","article-title":"Duodenal and Other Gastrointestinal Toxicity in Cervical and Endometrial Cancer Treated with Extended-Field Intensity Modulated Radiation Therapy to Paraaortic Lymph Nodes","volume":"85","author":"Poorvu","year":"2013","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"957","DOI":"10.3332\/ecancer.2019.957","article-title":"Early Toxicity and Treatment Outcomes of Extended Field-Intensity Modulated Radiotherapy for Cervical Cancer Patients with Para-Aortic Nodal Metastasis","volume":"13","author":"Gupta","year":"2019","journal-title":"Ecancermedicalscience"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1136\/ijgc-2022-004223","article-title":"PARa-aOrtic LymphAdenectomy in Locally Advanced Cervical Cancer (PAROLA Trial): A GINECO, ENGOT, and GCIG Study","volume":"33","author":"Martinez","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_64","first-page":"227","article-title":"TP009\/#1444 Compare Surgical Staging with Imaging in Locally Advanced Cervical Cancer: A Multicenter, Phase III Trial","volume":"32","author":"He","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1046\/j.1525-1438.1995.05040250.x","article-title":"Resection of Bulky Positive Lymph Nodes in Patients with Cervical Carcinoma","volume":"5","author":"Hacker","year":"1995","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1002\/(SICI)1097-0142(19980601)82:11<2241::AID-CNCR20>3.0.CO;2-T","article-title":"Pretreatment Surgical Staging of Patients with Cervical Carcinoma: The Case for Lymph Node Debulking","volume":"82","author":"Cosin","year":"1998","journal-title":"Cancer"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.1016\/j.jmig.2014.08.247","article-title":"Laparoscopic Debulking of Bulky Lymph Nodes in Patients with Cervical Carcinoma: Feasibility of the Technique and Surgical Outcomes","volume":"21","author":"Liang","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"123","DOI":"10.3802\/jgo.2008.19.2.123","article-title":"Experiences of Pretreatment Laparoscopic Surgical Staging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Study","volume":"19","author":"Lim","year":"2008","journal-title":"J. Gynecol. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1470-2045(20)30753-1","article-title":"MRI-Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer (EMBRACE-I): A Multicentre Prospective Cohort Study","volume":"22","author":"Tanderup","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"S486","DOI":"10.1016\/S0167-8140(23)08659-0","article-title":"OC-0603 Which Is the Optimal Lymph Node Management in Node Positive Cervical Cancer?","volume":"182","author":"Zaharie","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1136\/ijgc-2022-003357","article-title":"Treatment of Bulky Lymph Nodes in Locally Advanced Cervical Cancer: Boosting versus Debulking","volume":"32","author":"Olthof","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.3802\/jgo.2023.34.e55","article-title":"Efficacy of Lymph Node Dissection on Stage IIICr of Cervical Cancer before CCRT: Study Protocol for a Phase III, Randomized Controlled Clinical Trial (CQGOG0103)","volume":"34","author":"He","year":"2023","journal-title":"J. Gynecol. Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e0517","DOI":"10.1097\/MD.0000000000010517","article-title":"Clinical Impact of Boost Irradiation to Pelvic Lymph Node in Uterine Cervical Cancer Treated with Definitive Chemoradiotherapy","volume":"97","author":"Choi","year":"2018","journal-title":"Medicine"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.ygyno.2017.12.028","article-title":"Dose-Volume Effects in Pathologic Lymph Nodes in Locally Advanced Cervical Cancer","volume":"148","author":"Bacorro","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.ygyno.2014.08.037","article-title":"Methods, Safety, and Early Clinical Outcomes of Dose Escalation Using Simultaneous Integrated and Sequential Boosts in Patients with Locally Advanced Gynecologic Malignancies","volume":"135","author":"Boyle","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.brachy.2014.07.005","article-title":"Assessment of Radiation Doses to the Para-Aortic, Pelvic, and Inguinal Lymph Nodes Delivered by Image-Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer","volume":"14","author":"Mohamed","year":"2015","journal-title":"Brachytherapy"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.ijrobp.2019.03.020","article-title":"Importance of Technique, Target Selection, Contouring, Dose Prescription, and Dose-Planning in External Beam Radiation Therapy for Cervical Cancer: Evolution of Practice From EMBRACE-I to II","volume":"104","author":"Berger","year":"2019","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.brachy.2016.11.016","article-title":"Contribution of Image-Guided Adaptive Brachytherapy to Pelvic Nodes Treatment in Locally Advanced Cervical Cancer","volume":"16","author":"Bacorro","year":"2017","journal-title":"Brachytherapy"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ygyno.2013.07.085","article-title":"Radiation Therapy for Pelvic Lymph Node Metastasis from Uterine Cervical Cancer","volume":"131","author":"Hata","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1136\/ijgc-2020-001342","article-title":"Radiotherapy Dose Escalation on Pelvic Lymph Node Control in Patients with Cervical Cancer","volume":"31","author":"Gogineni","year":"2021","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/jrr\/rrt097","article-title":"Impact of Boost Irradiation on Pelvic Lymph Node Control in Patients with Cervical Cancer","volume":"55","author":"Wakatsuki","year":"2014","journal-title":"J. Radiat. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.3802\/jgo.2022.33.e59","article-title":"Prognostic Factors of Dose-Response Relationship for Nodal Control in Metastatic Lymph Nodes of Cervical Cancer Patients Undergoing Definitive Radiotherapy with Concurrent Chemotherapy","volume":"33","author":"Lee","year":"2022","journal-title":"J. Gynecol. Oncol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1120\/jacmp.v17i5.6123","article-title":"Simultaneously Integrated Boost (SIB) Spares OAR and Reduces Treatment Time in Locally Advanced Cervical Cancer","volume":"17","author":"Feng","year":"2016","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.ijrobp.2013.09.053","article-title":"Dosimetric Predictors of Duodenal Toxicity After Intensity Modulated Radiation Therapy for Treatment of the Para-Aortic Nodes in Gynecologic Cancer","volume":"88","author":"Verma","year":"2014","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e143","DOI":"10.1016\/j.ijrobp.2012.09.035","article-title":"Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer","volume":"85","author":"Kelly","year":"2013","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1097\/IGC.0b013e318286aa68","article-title":"Tolerance of the Small Bowel to Therapeutic Irradiation: A Focus on Late Toxicity in Patients Receiving Para-Aortic Nodal Irradiation for Gynecologic Malignancies","volume":"23","author":"Stanic","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s13566-020-00427-x","article-title":"Lymph Node\u2013Directed Simultaneous Integrated Boost in Patients with Clinically Lymph Node\u2013Positive Cervical Cancer Treated with Definitive Chemoradiotherapy: Clinical Outcomes and Toxicity","volume":"9","author":"Jethwa","year":"2020","journal-title":"J. Radiat. Oncol."},{"key":"ref_88","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. Oncol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1097\/IGC.0000000000001344","article-title":"Prophylactic Extended-Field Irradiation for Patients with Cervical Cancer Treated with Concurrent Chemoradiotherapy: A Propensity-Score Matching Analysis","volume":"28","author":"Wang","year":"2018","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/s13014-019-1431-9","article-title":"Evaluation of the Efficacy of Prophylactic Extended Field Irradiation in the Concomitant Chemoradiotherapy Treatment of Locally Advanced Cervical Cancer, Stage IIIB in the 2018 FIGO Classification","volume":"14","author":"Meng","year":"2019","journal-title":"Radiat. Oncol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.radonc.2021.08.020","article-title":"Risk Factors for Nodal Failure after Radiochemotherapy and Image Guided Brachytherapy in Locally Advanced Cervical Cancer: An EMBRACE Analysis","volume":"163","author":"Peters","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1001\/jama.1995.03530050035029","article-title":"Prophylactic Extended-Field Irradiation of Para-Aortic Lymph Nodes in Stages IIB and Bulky IB and IIA Cervical Carcinomas: Ten-Year Treatment Results of RTOG 79-20","volume":"274","author":"Rotman","year":"1995","journal-title":"JAMA"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.ygyno.2017.12.003","article-title":"Impact of Para-Aortic Recurrence Risk-Guided Intensity-Modulated Radiotherapy in Locally Advanced Cervical Cancer with Positive Pelvic Lymph Nodes","volume":"148","author":"Lee","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.clon.2014.08.008","article-title":"The Role of Elective Para-Aortic Lymph Node Irradiation in Patients with Locally Advanced Cervical Cancer","volume":"26","author":"Yap","year":"2014","journal-title":"Clin. Oncol."},{"key":"ref_95","first-page":"97","article-title":"The Impact of Para-Aortic Lymph Node Irradiation on Disease-Free Survival in Patients with Cervical Cancer: A Systematic Review and Meta-Analysis","volume":"35","author":"Bukkems","year":"2022","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.ijrobp.2007.01.026","article-title":"Extended-Field Irradiation and Intracavitary Brachytherapy Combined with Cisplatin Chemotherapy for Cervical Cancer with Positive Para-Aortic or High Common Iliac Lymph Nodes: Results of ARM 1 of RTOG 0116","volume":"68","author":"Small","year":"2007","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1200\/JCO.2004.07.197","article-title":"Pelvic Irradiation with Concurrent Chemotherapy Versus Pelvic and Para-Aortic Irradiation for High-Risk Cervical Cancer: An Update of Radiation Therapy Oncology Group Trial (RTOG) 90-01","volume":"22","author":"Eifel","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.radonc.2018.05.016","article-title":"Bowel Morbidity Following Radiochemotherapy and Image-Guided Adaptive Brachytherapy for Cervical Cancer: Physician- and Patient Reported Outcome from the EMBRACE Study","volume":"127","author":"Jensen","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.ijrobp.2020.10.006","article-title":"Dose-Volume Effects and Risk Factors for Late Diarrhea in Cervix Cancer Patients After Radiochemotherapy with Image Guided Adaptive Brachytherapy in the EMBRACE I Study","volume":"109","author":"Jensen","year":"2021","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.ejso.2011.08.128","article-title":"Metastasis to Deep Obturator and Para-Aortic Lymph Nodes in 649 Patients with Cervical Carcinoma","volume":"37","author":"Huang","year":"2011","journal-title":"Eur. J. Surg. Oncol. EJSO"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/(SICI)1097-0142(19990401)85:7<1547::AID-CNCR16>3.0.CO;2-2","article-title":"Incidence and Distribution Pattern of Pelvic and Paraaortic Lymph Node Metastasis in Patients with Stages IB, IIA, and IIB Cervical Carcinoma Treated with Radical Hysterectomy","volume":"85","author":"Sakuragi","year":"1999","journal-title":"Cancer"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"51840","DOI":"10.18632\/oncotarget.16025","article-title":"Predictive Factors of Para-Aortic Lymph Nodes Metastasis in Cervical Cancer Patients: A Retrospective Analysis Based on 723 Para-Aortic Lymphadenectomy Cases","volume":"8","author":"Han","year":"2017","journal-title":"Oncotarget"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.radonc.2018.02.013","article-title":"An Atlas to Aid Delineation of Para-Aortic Lymph Node Region in Cervical Cancer: Design and Validation of Contouring Guidelines","volume":"127","author":"Keenan","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_104","unstructured":"(2024, September 01). Pelvic RT Versus Prophylactic Extended-Field RT in Patients with Cervical Cancer. ClinicalTrials.gov Identifier: NCT03955367, Available online: https:\/\/www.clinicaltrials.gov\/study\/NCT03955367."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ygyno.2016.11.011","article-title":"Prediction Model for Para-Aortic Lymph Node Metastasis in Patients with Locally Advanced Cervical Cancer","volume":"144","author":"Shim","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00404-018-4829-y","article-title":"Nomogram for Predicting Para-Aortic Lymph Node Metastases in Patients with Cervical Cancer","volume":"298","author":"Wang","year":"2018","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"(2003). Neoadjuvant Chemotherapy for Cervical Cancer Meta-analysis Collaboration. Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer. Eur. J. Cancer, 39, 2470\u20132486.","DOI":"10.1016\/S0959-8049(03)00425-8"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1200\/JCO.2009.25.9663","article-title":"Phase III, Open-Label, Randomized Study Comparing Concurrent Gemcitabine Plus Cisplatin and Radiation Followed by Adjuvant Gemcitabine and Cisplatin Versus Concurrent Cisplatin and Radiation in Patients with Stage IIB to IVA Carcinoma of the Cervix","volume":"29","author":"Patel","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/S1470-2045(23)00147-X","article-title":"Adjuvant Chemotherapy Following Chemoradiotherapy as Primary Treatment for Locally Advanced Cervical Cancer versus Chemoradiotherapy Alone (OUTBACK): An International, Open-Label, Randomised, Phase 3 Trial","volume":"24","author":"Mileshkin","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e15535","DOI":"10.1200\/jco.2012.30.15_suppl.e15535","article-title":"CETUXICOL, a Phase II Trial Randomizing Standard Treatment with or without Cetuximab in Primary Cervical Cancer Treatment","volume":"30","author":"Scholl","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1002\/cncr.28471","article-title":"Phase 2 Trial of Erlotinib Combined with Cisplatin and Radiotherapy in Patients with Locally Advanced Cervical Cancer","volume":"120","author":"Moralez","year":"2014","journal-title":"Cancer"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ijrobp.2013.10.022","article-title":"RTOG 0417: Efficacy of Bevacizumab in Combination with Definitive Radiation Therapy and Cisplatin Chemotherapy in Untreated Patients with Locally Advanced Cervical Carcinoma","volume":"88","author":"Schefter","year":"2014","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"5502","DOI":"10.1200\/JCO.2023.41.16_suppl.5502","article-title":"Incorporation of Triapine (T) with Cisplatin Chemoradiation (CRT) for Locally Advanced Cervical and Vaginal Cancer: Results from NRG-GY006, a Phase III Randomized Trial","volume":"41","author":"Leath","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1136\/ijgc-2024-005572","article-title":"Are We Making Progress in Curing Advanced Cervical Cancer\u2014Again?","volume":"34","author":"Lindegaard","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F","article-title":"Human Papillomavirus Is a Necessary Cause of Invasive Cervical Cancer Worldwide","volume":"189","author":"Walboomers","year":"1999","journal-title":"J. Pathol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1038\/modpathol.2016.64","article-title":"Prognostic Effect of Different PD-L1 Expression Patterns in Squamous Cell Carcinoma and Adenocarcinoma of the Cervix","volume":"29","author":"Heeren","year":"2016","journal-title":"Mod. Pathol."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"e2025109","DOI":"10.1001\/jamanetworkopen.2020.25109","article-title":"Prevalence of High Tumor Mutational Burden and Association with Survival in Patients with Less Common Solid Tumors","volume":"3","author":"Shao","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"5505","DOI":"10.1200\/JCO.23.00914","article-title":"First-Line Pembrolizumab + Chemotherapy Versus Placebo + Chemotherapy for Persistent, Recurrent, or Metastatic Cervical Cancer: Final Overall Survival Results of KEYNOTE-826","volume":"41","author":"Monk","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(23)02405-4","article-title":"Atezolizumab plus Bevacizumab and Chemotherapy for Metastatic, Persistent, or Recurrent Cervical Cancer (BEATcc): A Randomised, Open-Label, Phase 3 Trial","volume":"403","author":"Oaknin","year":"2024","journal-title":"Lancet"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1016\/S0140-6736(24)02135-4","article-title":"Cadonilimab plus Platinum-Based Chemotherapy with or without Bevacizumab as First-Line Treatment for Persistent, Recurrent, or Metastatic Cervical Cancer (COMPASSION-16): A Randomised, Double-Blind, Placebo-Controlled Phase 3 Trial in China","volume":"404","author":"Wu","year":"2024","journal-title":"Lancet"},{"key":"ref_121","unstructured":"FDA (2024, October 01). Approves Pembrolizumab Combination for the First-Line Treatment of Cervical Cancer, Available online: https:\/\/www.fda.gov\/drugs\/resources-information-approved-drugs\/fda-approves-pembrolizumab-combination-first-line-treatment-cervical-cancer."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1136\/ijgc-2019-001135","article-title":"CALLA: Efficacy and Safety of Concurrent and Adjuvant Durvalumab with Chemoradiotherapy versus Chemoradiotherapy Alone in Women with Locally Advanced Cervical Cancer: A Phase III, Randomized, Double-Blind, Multicenter Study","volume":"30","author":"Mayadev","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_123","unstructured":"FDA (2024, October 01). Approves Pembrolizumab with Chemoradiotherapy for FIGO 2014 Stage III-IVA Cervical Cancer, Available online: https:\/\/www.fda.gov\/drugs\/resources-information-approved-drugs\/fda-approves-pembrolizumab-chemoradiotherapy-figo-2014-stage-iii-iva-cervical-cancer."},{"key":"ref_124","unstructured":"Liu, J., and Xiang, Y. (2024, October 01). A Study of AK104\/Placebo Combined with Chemoradiotherapy for the Treatment of Locally Advanced Cervical Cancer (AK104-305), Available online: https:\/\/clinicaltrials.gov\/study\/NCT05235516."},{"key":"ref_125","unstructured":"Roussy, G. (2024, October 01). Randomized Phase II Trial Assessing the Inhibitor of Programmed Cell Death Ligand 1 (Pd-L1) Immune Checkpoint Atezolizumab in Locally Advanced Cervical Cancer. (Atezolacc), Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03612791."},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Chen, J., Li, C., Cao, Y., Zhu, L., Zhang, B., You, J., Hou, H., Wang, J., and Yuan, Z. (2022). Toripalimab Combined with Concurrent Platinum-Based Chemoradiotherapy in Patients with Locally Advanced Cervical Cancer: An Open-Label, Single-Arm, Phase II Trial. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09866-w"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"S113","DOI":"10.1016\/j.ijrobp.2024.07.205","article-title":"IMMUNOCERV Phase II Trial Combining the HPV-Specific T Cell Immunotherapy PDS0101 with Chemoradiation for Treatment of Locally Advanced Cervical Cancer","volume":"120","author":"Grippin","year":"2024","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"3698","DOI":"10.1038\/s41467-023-39383-8","article-title":"Nivolumab plus Chemoradiotherapy in Locally-Advanced Cervical Cancer: The NICOL Phase 1 Trial","volume":"14","author":"Rodrigues","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"5501","DOI":"10.1200\/JCO.2023.41.16_suppl.5501","article-title":"In Situ Immune Impact of Nivolumab + Ipilimumab Combination before Standard Chemoradiation Therapy (RTCT) for FIGO IB3-IVA in Patients (Pts) with Cervical Squamous Carcinoma: COLIBRI Trial, a GINECO Study","volume":"41","author":"Ohkuma","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1136\/ijgc-2019-001012","article-title":"Anti-PD-L1 (Atezolizumab) as an Immune Primer and Concurrently with Extended-Field Chemoradiotherapy for Node-Positive Locally Advanced Cervical Cancer","volume":"30","author":"Mayadev","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"S285","DOI":"10.1016\/j.ygyno.2024.07.423","article-title":"eVOLVE-Cervical (GOG-3092\/ENGOT-Cx19\/GEICO133-C): A Prospective Phase III Study of Volrustomig versus Placebo after Definitive Chemoradiation among Women with High-Risk, Locally Advanced Cervical Cancer","volume":"190","author":"Randall","year":"2024","journal-title":"Gynecol. Oncol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1136\/ijgc-2022-003370","article-title":"ATOMICC Trial: A Randomized, Open-Label, Phase II Trial of Anti-PD1, Dostarlimab, as Maintenance Therapy for Patients with High-Risk Locally Advanced Cervical Cancer after Chemoradiation","volume":"32","author":"Grau","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"5621","DOI":"10.1158\/1078-0432.CCR-20-0776","article-title":"Immune Activation in Patients with Locally Advanced Cervical Cancer Treated with Ipilimumab Following Definitive Chemoradiation (GOG-9929)","volume":"26","author":"Enserro","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s13000-018-0770-4","article-title":"Tumor-Infiltrating CD8+ and FOXP3+ Lymphocytes before and after Neoadjuvant Chemotherapy in Cervical Cancer","volume":"13","author":"Liang","year":"2018","journal-title":"Diagn. Pathol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ejca.2022.06.034","article-title":"Immunologically Active Phenotype by Gene Expression Profiling Is Associated with Clinical Benefit from PD-1\/PD-L1 Inhibitors in Real-World Head and Neck and Lung Cancer Patients","volume":"174","author":"Foy","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.ijrobp.2011.09.048","article-title":"Correlation Between Radiation Dose to 18F-FDG-PET Defined Active Bone Marrow Subregions and Acute Hematologic Toxicity in Cervical Cancer Patients Treated with Chemoradiotherapy","volume":"83","author":"Rose","year":"2012","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ijrobp.2020.08.044","article-title":"Persistence of Late Substantial Patient-Reported Symptoms (LAPERS) After Radiochemotherapy Including Image Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: A Report From the EMBRACE Study","volume":"109","author":"Vittrup","year":"2021","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.3109\/0284186X.2014.928418","article-title":"A Comparison of Morbidity Following Conformal versus Intensity-Modulated Radiotherapy for Urinary Bladder Cancer","volume":"53","author":"Holmberg","year":"2014","journal-title":"Acta Oncol."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/0167-8140(94)90097-3","article-title":"The Volume Effect in Radiation-Related Late Small Bowel Complications: Results of a Clinical Study of the EORTC Radiotherapy Cooperative Group in Patients Treated for Rectal Carcinoma","volume":"32","author":"Letschert","year":"1994","journal-title":"Radiother. Oncol."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.phro.2019.06.002","article-title":"Robustness of Elective Lymph Node Target Coverage with Shrinking Planning Target Volume Margins in External Beam Radiotherapy of Locally Advanced Cervical Cancer","volume":"11","author":"Berger","year":"2019","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"110009","DOI":"10.1016\/j.radonc.2023.110009","article-title":"Nine Years of Plan of the Day for Cervical Cancer: Plan Library Remains Effective Compared to Fully Online-Adaptive Techniques","volume":"190","author":"Reijtenbagh","year":"2024","journal-title":"Radiother. Oncol."},{"key":"ref_142","doi-asserted-by":"crossref","unstructured":"Chuter, R.W., Brewster, F., Retout, L., Cree, A., Akt\u00fcrk, N., Hales, R., Benson, R., Hoskin, P., and McWilliam, A. (2023). Feasibility of Using a Dual Isocentre Technique for Treating Cervical Cancer on the 1.5 T MR-Linac. Phys. Med. Biol., 68.","DOI":"10.1088\/1361-6560\/acae18"},{"key":"ref_143","first-page":"100881","article-title":"MRI Guided Online Adaptive Radiotherapy and the Dosimetric Impact of Inter- and Intrafractional Motion in Patients with Cervical Cancer","volume":"50","author":"Ding","year":"2025","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.radonc.2020.02.011","article-title":"Target Coverage and Dose Criteria Based Evaluation of the First Clinical 1.5T MR-Linac SBRT Treatments of Lymph Node Oligometastases Compared with Conventional CBCT-Linac Treatment","volume":"146","author":"Winkel","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_145","doi-asserted-by":"crossref","unstructured":"Portelance, L., Corradini, S., Erickson, B., Lalondrelle, S., Padgett, K., Van Der Leij, F., Van Lier, A., and J\u00fcrgenliemk-Schulz, I. (2021). Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.628131"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.radonc.2016.06.016","article-title":"Which Cervical and Endometrial Cancer Patients Will Benefit Most from Intensity-Modulated Proton Therapy?","volume":"120","author":"Creutzberg","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14338\/IJPT-17-00027.1","article-title":"Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer","volume":"4","author":"Xu","year":"2017","journal-title":"Int. J. Part. Ther."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"2","DOI":"10.14338\/IJPT.13-00002.1","article-title":"Proton Reirradiation of Recurrent Rectal Cancer: Dosimetric Comparison, Toxicities, and Preliminary Outcomes","volume":"1","author":"Berman","year":"2014","journal-title":"Int. J. Part. Ther."},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Corbeau, A., Nout, R.A., Mens, J.W.M., Horeweg, N., Godart, J., Kerkhof, E.M., Kuipers, S.C., Van Poelgeest, M.I.E., Kroep, J.R., and Boere, I.A. (2021). PROTECT: Prospective Phase-II-Trial Evaluating Adaptive Proton Therapy for Cervical Cancer to Reduce the Impact on Morbidity and the Immune System. Cancers, 13.","DOI":"10.3390\/cancers13205179"},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1200\/JCO.2014.57.7122","article-title":"Nomograms Predicting Progression-Free Survival, Overall Survival, and Pelvic Recurrence in Locally Advanced Cervical Cancer Developed From an Analysis of Identifiable Prognostic Factors in Patients From NRG Oncology\/Gynecologic Oncology Group Randomized Trials of Chemoradiotherapy","volume":"33","author":"Rose","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1136\/ijgc-2023-004589","article-title":"Radiomics Systematic Review in Cervical Cancer: Gynecological Oncologists\u2019 Perspective","volume":"33","author":"Bizzarri","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ejrad.2018.07.024","article-title":"Value of [18F]FDG PET Radiomic Features and VEGF Expression in Predicting Pelvic Lymphatic Metastasis and Their Potential Relationship in Early-Stage Cervical Squamous Cell Carcinoma","volume":"106","author":"Li","year":"2018","journal-title":"Eur. J. Radiol."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"20180986","DOI":"10.1259\/bjr.20180986","article-title":"Feasibility of an ADC-Based Radiomics Model for Predicting Pelvic Lymph Node Metastases in Patients with Stage IB\u2013IIA Cervical Squamous Cell Carcinoma","volume":"92","author":"Yu","year":"2019","journal-title":"Br. J. Radiol."},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"Gui, B., Autorino, R., Micc\u00f2, M., Nardangeli, A., Pesce, A., Lenkowicz, J., Cusumano, D., Russo, L., Persiani, S., and Boldrini, L. (2021). Pretreatment MRI Radiomics Based Response Prediction Model in Locally Advanced Cervical Cancer. Diagnostics, 11.","DOI":"10.3390\/diagnostics11040631"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"1533033820983804","DOI":"10.1177\/1533033820983804","article-title":"Quantitative PET Imaging and Clinical Parameters as Predictive Factors for Patients with Cervical Carcinoma: Implications of a Prediction Model Generated Using Multi-Objective Support Vector Machine Learning","volume":"19","author":"Zhou","year":"2020","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.mri.2022.05.005","article-title":"IVIM-DWI and MRI-Based Radiomics in Cervical Cancer: Prediction of Concurrent Chemoradiotherapy Sensitivity in Combination with Clinical Prognostic Factors","volume":"91","author":"Zhang","year":"2022","journal-title":"Magn. Reson. Imaging"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40644-022-00474-2","article-title":"MRI-Based Radiomics Value for Predicting the Survival of Patients with Locally Advanced Cervical Squamous Cell Cancer Treated with Concurrent Chemoradiotherapy","volume":"22","author":"Zhang","year":"2022","journal-title":"Cancer Imaging"},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"e2011625","DOI":"10.1001\/jamanetworkopen.2020.11625","article-title":"Development of a Deep Learning Model to Identify Lymph Node Metastasis on Magnetic Resonance Imaging in Patients with Cervical Cancer","volume":"3","author":"Wu","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1002\/ijc.34190","article-title":"Randomized Multicenter Phase II Trial of Prophylactic Irradiation of Para-aortic Lymph Nodes in Advanced Cervical Cancer According to Tumor Hypoxia: Korean Radiation Oncology Group (KROG 07-01) Study","volume":"151","author":"Yoon","year":"2022","journal-title":"Int. J. Cancer"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.radonc.2016.04.009","article-title":"Prophylactic Irradiation of Para-Aortic Lymph Nodes for Patients with Locally Advanced Cervical Cancers with and without High CA9 Expression (KROG 07-01): A Randomized, Open-Label, Multicenter, Phase 2 Trial","volume":"120","author":"Kim","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijrobp.2024.07.2316","article-title":"Biomarker Expression and Clinical Outcomes in International Study of Chemoradiation and Magnetic Resonance Imaging-Based Image-Guided Brachytherapy for Locally Advanced Cervical Cancer: BIOEMBRACE","volume":"121","author":"Chopra","year":"2024","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"e12897","DOI":"10.1097\/MD.0000000000012897","article-title":"The Pretreatment Platelet-to-Lymphocyte Ratio Predicts Clinical Outcomes in Patients with Cervical Cancer: A Meta-Analysis","volume":"97","author":"Ma","year":"2018","journal-title":"Medicine"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.1200\/JCO.2011.37.5923","article-title":"Risk Assessment Tool for Distant Recurrence After Platinum-Based Concurrent Chemoradiation in Patients with Locally Advanced Cervical Cancer: A Korean Gynecologic Oncology Group Study","volume":"30","author":"Kang","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1200\/JCO.23.00954","article-title":"Clinical Validation of Human Papilloma Virus Circulating Tumor DNA for Early Detection of Residual Disease After Chemoradiation in Cervical Cancer","volume":"42","author":"Han","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"E293","DOI":"10.1016\/j.ijrobp.2016.06.1361","article-title":"Outcome After First Relapse in Patients with Locally Advanced Cervical Cancer Treated with Radical Radio (Chemo) Therapy","volume":"96","author":"Sasidharan","year":"2016","journal-title":"Int. J. Radiat. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/2\/202\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:25:53Z","timestamp":1759919153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/2\/202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,9]]},"references-count":165,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["cancers17020202"],"URL":"https:\/\/doi.org\/10.3390\/cancers17020202","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,9]]}}}