Introduction/Background*Malawi ranks as the country with the second highest CC incidence (72.9/100 000) and mortality (54.5/100 000).

The facilities face serious challenges as the country has no functioning radiotherapy center, which leaves patients with Locally Advance Cervical Cancer (LACC) without curative options. We adopted NACT as a down-staging strategy for patients with LACC, to provide them curative options.

The aim of the survey was to assess whether NACT is an effective strategy in being able to provide adequate surgery for stage IB3, IIA2, and IIB patients.

Methodology Cohort analysis of data from women (>=18 y.o.) receiving a Radical Hysterectomy (RH) in MSF Malawian cancer program between December 2019 and March 2021.

Initial and post-pathology FIGO staging were described and compared according to individual characteristics and therapy received.

Comparisons of proportions were performed using the appropriate statistical test.

All analyses were performed using Stata16 (Stata Corp).

Data was extracted from Redcap Malawi and a Microsoft Excel database.

Data analyses were performed using Excel and Stata 16 (version 16.1).

Result(s)*Between December 1, 2019 and March 30, 2021, 97 women undergo RH at MSF Cervical Cancer project at Queen Elizabeth Central Hospital (QECH).

Out of these patients, 47 received NACT.

Among those patients, we observe a change in FIGO stage for 46 (p -value <0.005).

NACT improved post-pathology FIGO stage for 42 patients (p-value<0.005): 17 patients had complete pathological response, and 25 presented with partial response.

Four patients clinically worsened FIGO stage, requiring chemo radiation as treatment.

There was a significant decrease in histopathology results for parametrium, LVSI, LN involvement, and margin involvement (p-value<0.005).

According to Clavien-Dindo Classification 12 patients had post operative complications: 5 Grade I, 1 Grade II, 4 Grade III a, and 2 Grade III b. Two patients died after NACT and RH died (4.3%).

Patients that received NACT in the MSF cohort had 17.3% less complications than non-NACT patients.

Conclusion*In the absence of radiation therapy option, NACT seems to be an effective strategy in improving patient FIGO stage enough for adequate surgery.

Long term follow up is required to assess its impact on disease free survival.