| Cervical cancer is the fourth leading cause of cancer death among women worldwide. Pelvic and para-aortic lymph node metastasis is an independent risk factor affecting its prognosis. Currently, imaging techniques such as CT, MRI, and 18F-FDG PET-CT are useful references for detecting lymph node metastasis. However, they have limitations and must be interpreted in conjunction with comprehensive clinical judgment. For cervical cancer with pelvic and para-aortic lymph node metastasis, the standard treatment is cisplatin-based concurrent chemoradiotherapy. For patients with para-aortic lymph node metastasis, extended-field irradiation can be considered to improve survival, while carefully balancing the increased risk of normal tissue damage. The survival benefit of lymphadenectomy lacks confirmation from prospective randomized controlled trials, and its combination with radiotherapy may increase complications. Although consolidation chemotherapy in locally advanced cervical cancer has not shown a survival advantage, patients with retroperitoneal lymph node metastasis may still benefit from the adjuvant chemotherapy. This point still needs to be verified through prospective studies. Immunotherapy, such as pembrolizumab combined with concurrent chemoradiotherapy, has significantly improved survival in high-risk patients in the KEYNOTE-A18 study, representing a novel therapeutic approach. Nimotuzumab can be recommended for the treatment of elderly patients or patients unable to tolerate chemotherapy with locally advanced cervical cancer. Future research should focus on developing diagnostic models that integrate imaging and molecular biomarkers, conducting dedicated clinical trials for subgroups of stage IIIC disease, and exploring precision combination strategies of immunotherapy and targeted therapy based on multi-omics information and dynamic monitoring via liquid biopsy, with the goal of transitioning from a "stage-oriented" to a "biology-oriented" individualized treatment model. |
