• Overall survival [ Time Frame: 3-year ]
  Overall survival is calculated from randomization to death from any cause.
• Distant failure-free survival [ Time Frame: 3-year ]
  Distant failure-free survival is defined as the time from randomization to distant metastasis or death from any cause, whichever is first.
• Para-aortic lymph nodes failure rate [ Time Frame: 3-year ]
  The incidence of para-aortic lymph nodes failure.
• Acute toxicity evaluated with CTCAE 5.0 [ Time Frame: From the start of treatment to 3 months after treatment. ]
  Evaluated with CTCAE 5.0
• Late toxicity evaluated with Radiation Therapy Oncology Group (RTOG)/EORTC late radiation morbidity scoring scheme [ Time Frame: 3-year ]
  Evaluated with Radiation Therapy Oncology Group (RTOG)/EORTC late radiation morbidity scoring scheme

• Radiation: Prophylactic extended-field Irradiation
  CTV covers pelvis and para-aortic lymph nodes region.
  Other Name: Prophylactic radiotherapy for para-aortic lymph nodes region
• Radiation: Pelvic irradiation
  CTV covers pelvis.
  Other Name: Pelvic radiotherapy
• Radiation: Intracavitary brachytherapy
  The total dose delivered to point A or high-risk CTV is ≥80Gy. For patients with larger-volume cervical tumor, the total dose is ≥85Gy.
  Other Name: Brachytherapy
• Drug: Concurrent chemotherapy
  Cisplatin based concurrent chemotherapy, including cisplatin as a single agent or cisplatin plus Paclitaxel.
  Other Name: Chemotherapy

• Active Comparator: Pelvic Irradiation
  Patients receive concurrent chemoradiotherapy. The CTV includes the gross tumor, cervix, uterus, parametrium, upper part of the vagina, and pelvic lymph nodes regions. The upper border of CTV is at the level of aortic bifurcation. A dose of 45-50.4Gy is delivered to CTV with IMRT.
  Interventions:

  • Radiation: Pelvic irradiation
  • Radiation: Intracavitary brachytherapy
  • Drug: Concurrent chemotherapy
• Experimental: Prophylactic EFI
  Patients receive concurrent chemoradiotherapy. The CTV includes the gross tumor, cervix, uterus, parametrium, upper part of the vagina, pelvic lymph nodes regions and para-aortic lymph nodes region. The upper border of CTV is at the level of renal vessels. A dose of 45-50.4Gy is delivered to CTV with IMRT.
  Interventions:

  • Radiation: Prophylactic extended-field Irradiation
  • Radiation: Intracavitary brachytherapy
  • Drug: Concurrent chemotherapy

Inclusion Criteria:

1. Patients must be informed of the investigational nature of this study and give written informed consent with 30 days before treatment.
2. Age ≥18 years and ≤ 70 years.
3. Patients with newly histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma, et al.
4. No evidence of para-aortic metastatic lymph nodes (MLNs) on CT, MRI or positron emission tomograph (PET)/CT.*
5. No evidence of distant metastasis (FIGO stage IVB).

6. At least meet one of the following characteristics:

   1. Number of pelvic MLNs ≥ 2;
   2. Short diameter of pelvic MLNs ≥ 1.5cm; *
   3. Parametrial involvement to the pelvic wall ＃.
7. Satisfactory performance: Eastern Cooperative Oncology Group (ECOG) score ≥ 2.
8. Adequate marrow: neutrophile granulocyte count ≥1.5*10^9/L, hemoglobin ≥ 80 g/L, platelet count ≥100*10^9/L.

9. Normal liver and kidney function: Creatinine (Cr) < 1.5 mg/dl, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) < 2*upper limit of normal (ULN).

   • MLNs refer to positive lymph nodes confirmed by PET/CT or lymph nodes with short diameter ≥ 1 cm on CT or MRI.

     • Parametrial involvement to the pelvic wall is diagnosed with gynecological examination or MRI;

Exclusion Criteria:

1. With common iliac MLNs.
2. Tumor extended to the lower third of the vagina.
3. Tumor spread to mucosa of the bladder or rectum.
4. Prior surgery (including pelvic or para-aortic lymph nodes resection, except for tumor biopsy), radiotherapy or chemotherapy to primary tumor or nodes.
5. Prior malignancy.
6. History of previous radiotherapy to the abdomen or pelvis.
7. Pregnancy or lactation.
8. Active inflammatory bowel disease, or history of severe stomach or duodenal ulcer.
9. Active infection with fever.
10. Patients with unacceptable risk that intracavitary brachytherapy can not be conducted.
11. Any severe disease which may bring unacceptable risk or affect the compliance of the trial, for example, unstable cardiac disease requiring treatment, renal disease, chronic hepatitis, diabetes with poor control, and emotional disturbance.

• Peking University First Hospital
• Cangzhou Central Hospital
• The Second Affiliated Hospital of Dalian Medical University
• Tumor Hospital of Gansu
• First Affiliated Hospital of Guangxi Medical University
• Harbin Medical University Third Affiliated Hospital
• Wuhan Union Hospital, China
• First Affiliated Hospital of Chongqing Medical University
• Guizhou Provincial People's Hospital
• Second Hospital of Jilin University
• China-Japan Union Hospital, Jilin University
• Jilin Provincial Tumor Hospital
• Jiangsu Cancer Institute & Hospital
• The 940th Hospital of Joint Logistics Support Force，PLA.
• General Hospital of Benxi Iron & Steel Industry Group
• The Affiliated Hospital of Inner Mongolia Medical University
• General Hospital of Ningxia Medical University
• Beijing Obstetrics and Gynecology Hospital
• Tangshan People's Hospital
• Zhongnan Hospital of Wuhan University & Second Clinical Hospital of Wuhan University
• Second Affiliated Hospital of Xi'an Jiaotong University
• First Affiliated Hospital Xi'an Jiaotong University
• The Affiliated Tumor Hospital of Xinjiang Medical University
• Zhejiang Cancer Hospital
• The First Affiliated Hospital of Zhengzhou University
• Affiliated Cancer Hospital of Zhengzhou University
• Seventh Medical Center of PLA Army General Hospital
• Shengjing Hospital
• Cancer Institute and Hospital, Chinese Academy of Medical Sciences
• Xiangya Hospital of Central South University
• Henan Provincial People's Hospital
• Xi'an Gaoxin Hospital
• West China Second University Hospital