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已出现区域淋巴结转移，这与根治性治疗后不良生存结局相关。在当今放化疗（CRT）与图像引导自适应近距离放疗（IGABT）时代，局部晚期宫颈癌（LACC）患者虽能获得优异的局部控制效果，但淋巴结复发仍是治愈面临的主要挑战。为优化淋巴结阳性LACC患者的治疗效果并降低淋巴结复发率，目前已探索多种治疗策略，包括手术淋巴结分期或清扫方法、放疗剂量递增方案（如对受累淋巴结采用调强放疗联合同步整合推量技术），以及对亚临床腹主动脉旁病灶的预防性治疗。此外，新兴精准放疗技术如磁共振引导放疗与质子治疗日益受到关注，这些技术有望进一步提升治疗效益比。本文综述了淋巴结转移的检测方法、淋巴结阳性LACC的治疗选择、淋巴结放疗技术及其临床疗效与毒性证据，并探讨了全身治疗的最新进展及可能影响淋巴结阳性LACC治疗格局的新型治疗方向。
肿瘤(癌症)患者之家