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Background <p>In locally advanced cervical cancer, the INTERLACE study showed improved survival with short-course induction chemotherapy (NACT) followed by chemoradiotherapy (CTRT) and brachytherapy. However, its viability and outcomes in low- and middle-income countries remain underexplored. Our study aimed to evaluate the challenges for implementation, toxicity, and response rates with NACT in the Indian context.</p> Methods <p>This prospective, single-arm study included 87 cervical carcinoma patients (stages IB2–IVA). All patients were planned to receive six cycles of weekly NACT with paclitaxel (80&#xa0;mg/m<sup>2</sup>) and carboplatin (AUC 2), followed by cisplatin-based CTRT and brachytherapy. The adherence to the radiotherapy protocol, response rates, and toxicities were assessed.</p> Results <p>Out of 87 patients, 89.6% completed six cycles of induction chemotherapy. The median gap between NACT and CTRT initiation was 19&#xa0;days. 70% of patients received ≥ 4 cycles of concurrent cisplatin, and 86% completed the full radiotherapy course. The most common hematological toxicity was anemia; 24% of patients experienced ≥ grade 3 hematological toxicity. The median overall radiotherapy treatment time was 53 days, and the treatment dropout rate was 14%. 91% of our patients had a good response to NACT, and 90.5% had a complete response at 3 months following treatment.</p> Conclusion <p>The short-course NACT lowers adherence to CTRT but led to encouraging response rates in the Indian population. While the response rates are high, the impact of toxicities and logistic delays on long-term outcomes needs follow-up. It may be considered for carefully selected patients, provided it does not compromise the optimal chemoradiation protocol.</p>

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Practical Challenges and Implementation Considerations for Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer: Experience from a Tertiary Cancer Center in India

  • 期刊论文

  • 发表日期：

    2025年8月30日

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  • Naga Prasanthi Akkineni,
  • Madhuri Kavikondala,
  • Surya Vamsi Penumarti,
  • P. Vaishnavi,
  • M. V. T. Krishna Mohan,
  • A. Santa,
  • Anitha Mandava,
  • R. Rajagopalan,
  • T. Subramanyeshwar Rao,
  • Deleep Kumar Gudipudi,
  • Senthil J. Rajappa

摘要

Background

In locally advanced cervical cancer, the INTERLACE study showed improved survival with short-course induction chemotherapy (NACT) followed by chemoradiotherapy (CTRT) and brachytherapy. However, its viability and outcomes in low- and middle-income countries remain underexplored. Our study aimed to evaluate the challenges for implementation, toxicity, and response rates with NACT in the Indian context.

Methods

This prospective, single-arm study included 87 cervical carcinoma patients (stages IB2–IVA). All patients were planned to receive six cycles of weekly NACT with paclitaxel (80 mg/m2) and carboplatin (AUC 2), followed by cisplatin-based CTRT and brachytherapy. The adherence to the radiotherapy protocol, response rates, and toxicities were assessed.

Results

Out of 87 patients, 89.6% completed six cycles of induction chemotherapy. The median gap between NACT and CTRT initiation was 19 days. 70% of patients received ≥ 4 cycles of concurrent cisplatin, and 86% completed the full radiotherapy course. The most common hematological toxicity was anemia; 24% of patients experienced ≥ grade 3 hematological toxicity. The median overall radiotherapy treatment time was 53 days, and the treatment dropout rate was 14%. 91% of our patients had a good response to NACT, and 90.5% had a complete response at 3 months following treatment.

Conclusion

The short-course NACT lowers adherence to CTRT but led to encouraging response rates in the Indian population. While the response rates are high, the impact of toxicities and logistic delays on long-term outcomes needs follow-up. It may be considered for carefully selected patients, provided it does not compromise the optimal chemoradiation protocol.