Objective  To explore the efficacy and safety of simultaneous integrated boost therapy that is based on intensity-modulated radiotherapy (IMRT) technology for stage ⅢCr cervical cancer-positive lymph nodes.

Methods  Eighty-two patients with stage ⅢCr (ⅢC1r and ⅢC2r) cervical cancer-positive lymph nodes diagnosed and treated in the Affiliated Cancer Hospital of Guizhou Medical University from January 2020 to October 2022, with the age of 52.3±10.5 years, were collected for a cross-sectional study. These patients were treated by applying IMRT, in which the cervical mass and metastatic lymph nodes were treated with 50.4 Gy/28F and 60.2 Gy/28F radiotherapy, respectively. The patients received 4–6 cycles of cisplatin or two cycles of paclitaxel+cisplatin regimen chemotherapy combined with 30.0 Gy/6F three-dimensional afterloading brachytherapy. The recent efficacy, survival, and adverse reactions of radiotherapy and chemotherapy were observed, and counting data were tested by rank-sum test. Kaplan-Meier curves were used to estimate patient survival, and COX regression analysis was used to assess the impact of each clinicopathological feature on patient survival time and outcome.

Results  The median follow-up of the 82 patients was 27 months (range of 9–44 months). Recent efficacy evaluations showed a complete remission rate of 79%(65/82), a partial remission rate of 21%(17/82), and objective remission rates of 100%(71/71, 11/11) for patients with stages ⅢC1r and ⅢC2r. The 2- and 3-year overall survival rates of all patients were 92%, and the 2- and 3-year progression-free survival rates were 79% and 74%, respectively. The results of COX regression analysis showed that International Federation of Gynecology and Obstetrics stage was an independent prognostic factor for progression-free survival in patients with cervical cancer-positive lymph nodes (HR=4.099, 95%CI: 1.174–14.311, P=0.027). The incidence of acute grades 3 and 4 myelosuppression after radiotherapy and chemotherapy were 52.4%(43/82) and 6.1%(5/82), respectively. Grade 3 acute radiation enteritis, manifested as intestinal obstruction and diarrhea, was observed in three patients.

Conclusion  The simultaneous integrated boost technique based on IMRT in the treatment of positive lymph nodes in patients with stage ⅢCr cervical cancer achieved good clinical efficacy with adverse reactions within acceptable limits.