Introduction Locally advanced cervical cancer (LACC) poses significant challenges in treatment. There has been a trend towards short course induction chemotherapy (IC) followed by chemo-radiation (CCRT) for LACC, based on the promising outcomes from the INTERLACE trial. This abstract elucidates on the hurdles and accomplishments encountered during its implementation.

Methods We summarized the abstract into the challenges and benefits of implementing the INTERLACE protocol in our institution.

Results Challenges: Protocol timelines with respect to CCRT initiation after IC was a critical factor, with haematological toxicities such as anaemia from IC delaying the start of CCRT. IC also heightened gastrointestinal toxicities during CCRT. Effective communication between medical and radiation oncologists to ensure timely CCRT initiation was challenging. We found that patient assessments by week 5 of chemotherapy helps to facilitate timely radiotherapy planning, including CT simulation, contouring, and treatment preparation, all of which are inherently time-consuming processes. Benefits: Patients could begin chemotherapy immediately after clinical and radiological assessment, circumventing the delays often associated with upfront CCRT. The most significant advantage was the substantial downsizing of gross disease achieved through IC which facilitated a more precise treatment planning process during both External Beam Radiotherapy and brachytherapy. This may diminish the need for interstitial needles during brachytherapy.

Conclusion/Implications In this abstract we highlight the challenges and feasibility of starting Induction Chemotherapy followed by chemo-radiation protocol in LACC. Through careful navigation of logistical hurdles and the institutional advantages, we were able to enhance the safety and efficacy in the treatment of locally advanced cervical cancer.