S460
Clinical - Gynaecological
ESTRO 2026
Purpose/Objective: Standard of care for locally advanced cervical cancer is external beam radiotherapy and concurrent chemotherapy followed by image- guided brachytherapy (IGABT), achieving excellent local control rates (~90%), 93% control beyond pelvis and 82% five year survival proven in EMBRACE I/II studies. Neoadjuvant chemotherapy (NACT) targets 10-20% micrometastasis outside the pelvis conferring a 10% survival benefit. But, can lead to increased overall treatment time (OTT), accelerated tumor repopulation, increased toxicities and poor quality of life. Treatment delays beyond 56 days in OTT are linked to reduced local control. Approximately 30% are resistant to NACT resulting in resistant tumor clones and reduced locoregional control. Thus, questioning the addition of NACT in the current era of modern radiotherapy techniques and HDR IGABT.This study evaluates the practical deliverability, overall treatment duration and toxicity profile of NACT prior to CTRT in our cohort. Material/Methods: A retrospective analysis of 48 patients diagnosed with cervical cancer out of which 10 patients with locally advanced cervical carcinoma were treated with NACT (paclitaxel 80 mg/m ² + carboplatin AUC 2, weekly × 6) followed by radical CTRT (45 Gy/25 fractions with simultaneous integrated boost (SIB) to involved nodes + weekly cisplatin) and HDR brachytherapy between April 2024 to November 2025 at a tertiary cancer centre in Bangalore, Karnataka, India. Acute toxicities were graded as per CTCAE v5.0 (Common terminology criteria for adverse events). Results: Eight out of 10 patients completed all six cycles of NACT. The mean interval between NACT completion to CTRT initiation was 11.6 days and from CTRT completion to brachytherapy was 21 days. The mean OTT was 106 days. All completed the CTRT, though OTT exceeded 56 days in all cases. Five patients developed grade II–III
prolonged radiotherapy duration exceeding 56 days are associated with significantly poorer PFS. Systematic comparison of treatment timelines and implementation of workflow optimization strategies, such as
rapid and accurate pre-treatment diagnostics, MDT triage, improved
radiotherapy capacities (spatial, staffing and technical), and patient flow monitoring are urgently needed to improve oncological outcomes and long-term disease control. References: 1) Bray F, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74(3):229- 63.2) Cibula D, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Int.J Gynecol Cancer 33(2023):649-66.3) Kavuma A, et al. Impact of Waiting Time and Treatment Duration on Short-Term Outcomes for Patients With Locally Advanced Cervical Cancer at the Uganda Cancer Institute: The Challenges in Resource-Limited Settings. JCO Glob Oncol 2025;11:e2500325.4) Ramiah D, et al. Implementing Remote Radiotherapy Planning to Increase Patient Flow at a Johannesburg Academic Hospital, South Africa. JMIR Res Protoc 2025;14:e60131. Keywords: cervical cancer, FIGO stage III, radiotherapy Digital Poster 2885 Real world data on Neoadjuvant chemotherapy in carcinoma uterine cervix: time to tie the LACES or EMBRACE the standard? Sagarika Nithyanand, Ayesha Maniyar, Ram C Alva, Prathima Sivaguru, Belliappa MS, Suneetha N, Vidya Austin, Jayant Bhargav, Kruthi Shetty Radiation Oncology, Aster CMI Hospital, Bengaluru, India
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