PARa-aOrtic LymphAdenectomy in Locally Advanced Cervical Cancer

Inclusion Criteria:

1. Age ≥ 18 years at time of study entry

2. Newly diagnosed histologically proven cervical squamous carcinoma, adenocarcinoma,or adenosquamous tumor

3. FIGO stage IIIC1 (FIGO 2018) cervical cancer with FDG-PET/CT showing FDG-positivepelvic nodes and FDG-negative PALN including equivocal lymph nodes in the commoniliac and para-aortic regions. The highest positive lymph node must be locatedinferior to the common iliac bifurcation in both sides (anatomical level 1).

4. Patients with TNM T stage I-IIIB.

5. FIGO stage IIIC1 cervical cancer by positive pelvic sentinel lymph node fromsurgical staging (either intraoperative assessment (frozen section) or from finalhistology - patients are not eligible after radical hysterectomy, and FDG-negativecommon iliac of para-aortic lymph node on PET/CT (performed before or after SLNprocedure)

6. Patient eligible for pelvic radiotherapy and cisplatin-based chemotherapy with acurative intent as confirmed by a multidisciplinary board

7. ECOG performance status < 2 i.e. 0 or 1

8. Life expectancy more than 12 months

9. Pretherapeutic imaging FDG-PET/CT images should be available for central review

10. Prior validation of the surgeon's participation in the study by the QualityAssurance Comity

11. Women should be post-menopaused or willing to accept the use of an effectivecontraceptive regimen during the treatment period. All non-menopaused women shouldhave a negative pregnancy test within 72 hours prior to study entry.

12. Patient is willing and able to comply with the protocol for the duration of thestudy including undergoing treatment and scheduled visits and examinations includingfollow up

13. Not applicable since protocol revision V4. Patient participating to other clinicaltrials including immunotherapy strategies or adjuvant chemotherapy is also eligiblefor the study. Adjuvant treatment must be decided prior to randomization

14. Signed informed consent

15. Patient affiliated to a Social Health Insurance in France (French patients only).

Exclusion Criteria:

1. Unequivocal positive common iliac or para-aortic lymph nodes at pretherapeuticimaging FDG-PET/CT

2. Negative or equivocal pelvic lymph nodes at pretherapeutic imaging FDG-PET/CT

3. Metastatic disease confirmed by FDG-PET/CT

4. Other histologies than adenocarcinoma, squamous cell carcinoma and adenosquamouscarcinoma

5. Contraindication for cisplatin-based chemotherapy

6. Women who received any prior treatment for cervical cancer

7. Prior surgery for the cervical cancer, except for cone procedure and pelvic lymphnode staging

8. Previous pelvic radiotherapy

9. History of another primary malignancy except for: Malignancy treated with curativeintent and with no known active disease after 5 years, adequately treatednon-melanoma skin cancer or lentigo maligna without evidence of disease, adequatelytreated carcinoma in situ (any location) without evidence of disease.

10. Any psychological, familial, geographic or social situation, according to thejudgment of investigator, potentially preventing the provision of informed consentor compliance to study procedure

11. Patient who has forfeited his/her freedom by administrative or legal award or who isunder legal protection (curatorship and guardianship, protection of justice).