Paraaortic nodal irradiation (PAI) was thought to be useful in the treatment of cervical cancer, but its clinical application has been limited by a relatively high morbidity. To reduce this morbidity, we routinely applied the four-field technique in PAI. To clarify its efficacy, clinical data were retrospectively analyzed. Ninety-seven patients with cervical cancer, who received a minimum 40 Gy of paraaortic irradiation between 1976 and 1994, were enrolled in the analysis. The patients were prescribed PAI using four-field portals with 10 MV photons (mean 50.4 Gy, range 40-70 Gy). The 5-year cause-specific survival rate was 32.2%. As for sequelae determined using the French-Italian glossary, G1a/G2a of stomach and duodenum developed in 26.8/1.0%, G2b of small bowel in 3.1%, G1b of nonspecific abdominal symptoms and/or signs in 12.4%, and G2 of bone in 3.1%. The operative history group had a slightly larger incidence of gastrointestinal complications than those without operative history, but the difference was not statistically significant. Application of four-field portals in PAI was useful, with acceptably low toxicity and successful compliance for moderate-to-high dose irradiation. This suggests that PAI may greatly contribute to the improvement of the therapeutic outcome of cervical carcinoma.