Unveiling The Impact of Prophylactic Para-Aortic Lymph Nodes Irradiation in Cervical Cancer: Meta-Analysis of Randomized Controlled Trials

Soetomo, Cindy Thiovany; Gunawan, Made Favian Budi; De Liyis, Bryan Gervais; Dewi, Putu Emilia; Budiana, I Nyoman Gede

doi:10.31557/APJCP.2025.26.8.3075

Unveiling The Impact of Prophylactic Para-Aortic Lymph Nodes Irradiation in Cervical Cancer: Meta-Analysis of Randomized Controlled Trials

Document Type : Research Articles

Authors

¹ Faculty of Medicine, Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Bali, Indonesia.

² Department of Obstetrics and Gynecology, Faculty of Medicine, Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Bali, Indonesia.

10.31557/APJCP.2025.26.8.3075

Abstract

Objective: This study assessed the impact of prophylactic para-aortic lymph node (PALN) irradiation with extended-field radiotherapy (EF-RT) in individuals with locally advanced cervical cancer. The principal objective was overall survival (OS), whereas the secondary outcomes included PALN metastases, full remission, pelvic recurrence, distant metastasis, and mortality attributable to cervical cancer. Methods: A thorough search was performed in Pubmed, Cochrane Central Register of Controlled Trials, and Science Direct in November 2023, following PRISMA procedures. Randomized trials comparing EF-RT to pelvic-only radiation for locally advanced cervical cancer without PALN involvement were incorporated. A meta-analysis was conducted using RevMan software to evaluate the Hazard Ratio (HR) for overall survival (OS) and the Odds Ratio (OR) for additional outcomes. Result: Six Randomized Controlled Trials involving 1,028 patients (508 in EF-RT group and 520 in pelvic-only radiotherapy group) were analyzed. EF-RT significantly reduced para-aortic lymph node metastases compared to standard pelvic radiotherapy (OR = 0.23, 95% CI [0.12;0.44], p-value<0.00001, 4 studies), but not significantly improve overall survival (HR = 0.97, 95% CI [0.82;1.16], p-value>0.05, 6 studies) nor other outcomes. EF-RT was also associated with increased gastrointestinal but not urological or gynecological complications. Conclusion: EF-RT as a prophylactic treatment for cervical cancer patients with negative PALN metastasis significantly reduces para-aortic lymph node metastatic events, nonetheless, it is improbable to offer any advantages regarding overall survival, managed pelvic illness, or distant metastatic sites. Furthermore, its adverse effects on gastrointestinal problems were observed to exceed those of conventional pelvic irradiation, necessitating further consideration.

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