Cheung Elki Sze-Nga, Wu Philip Yuguang
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
Cancers (Basel). 2025 Jan 9;17(2):202. doi: 10.3390/cancers17020202.
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.
约36%的宫颈癌患者在确诊时出现区域淋巴结转移，这与根治性治疗后的不良生存结果相关。在放化疗（CRT）和图像引导下的自适应近距离放疗（IGABT）的现代时代，局部晚期宫颈癌（LACC）患者可实现良好的局部控制，但淋巴结失败仍然是治愈的主要挑战。为了优化淋巴结阳性LACC的治疗结果并降低淋巴结失败的发生率，人们探索了各种治疗方法，包括手术淋巴结分期或清扫方法、放疗剂量递增策略，如对受累淋巴结进行调强放疗（IMRT）同步整合加量（SIB），以及对亚临床腹主动脉旁（PAO）疾病的选择性治疗。此外，人们对新兴的精确放疗技术，如磁共振引导放疗（MRgRT）和质子治疗越来越感兴趣，这些技术可能会进一步提高治疗比。本综述概述了淋巴结转移的各种检测方法、淋巴结阳性LACC的治疗选择、淋巴结放疗技术及其疗效和毒性方面的临床证据。此外，还讨论了全身治疗的最新进展以及可能影响淋巴结阳性LACC管理的有前景的新治疗方向。
