{ "abstract": "Objective: Achieving optimal brachytherapy coverage for bulky cervical tumors (>30 cc) remains challenging, and the ideal treatment approach is unclear. This study describes real-world tumor volume response, brachytherapy dose delivery, and toxicity in patients treated with an INTERLACE-style induction chemotherapy regimen followed by chemoradiation and MRI-guided adaptive brachytherapy. Methods: This retrospective, two-institution cohort included eight patients with locally advanced cervical cancer treated with weekly carboplatin/paclitaxel induction chemotherapy followed by cisplatin-based chemoradiation and MRI-guided brachytherapy. All three serial tumor measurements (at diagnosis, after induction chemotherapy, and after chemoradiation/before brachytherapy) were obtained by pelvic MRI. Gross tumor volumes (GTV) were contoured by the treating radiation oncologist; organ-at-risk volumes were delineated by treating physicians. Results: FIGO stage was IIIC1 in 6 patients, IIA in 1, and IB3 in 1. Five patients (62.5%) were PD-L1 positive. Seven patients received tandem-and-ovoid brachytherapy and one received a Syed-Neblett interstitial implant. Median GTV was 88.3 cc (range 18–370) at diagnosis, 15.3 cc (range 0–187.1) after induction chemotherapy, and 2.2 cc (range 0–11.5) after chemoradiation. Median per-patient GTV reduction was 70% (range, 45–100%) after induction chemotherapy alone and 97% (range 74–100%) by completion of chemoradiation. Seven patients presented with bulky disease (>30 cc); three remained bulky after induction chemotherapy and none after chemoradiation. Median high-risk clinical target volume (HR-CTV) D90 cumulative dose in 2-Gy fraction equivalents (EQ.D2) was 90.5 Gy (range 87–93.7) and median HR-CTV D98 was 79.8 Gy EQ.D2 (range 77.2–84.8; n = 7). Grade ≥ 3 hematologic toxicity was more common during chemoradiation than during induction chemotherapy (neutropenia in 3/8 [37.5%] vs 1/8 [12.5%]; leukopenia in 2/8 [25%] vs 0/8 [0%]). Thrombocytopenia (1/8,12.5%) and one case of anemia were observed exclusively during induction chemotherapy. Two patients discontinued cisplatin early because of hematologic toxicity. Seven of eight patients achieved a complete metabolic response on PET at 3 months post-treatment and remained disease-free at last follow-up (median 62.4 months; range 23.0–72.9). Conclusion: In this real-world cohort, INTERLACE-style induction chemotherapy produced substantial tumor regression that facilitated tandem-and-ovoid brachytherapy in most patients while achieving EMBRACE-aligned HR-CTV doses with manageable, phase-specific toxicity. These hypothesis-generating findings warrant confirmation in larger, prospective, and comparative cohorts.", "abstract_shown": true, "affiliations": [ "Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, 1919 Old Spanish Trl, Houston, TX, 77054, USA; Corresponding authors.", "Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, 1919 Old Spanish Trl, Houston, TX, 77054, USA", "Department of Gynecologic Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA", "Department of Gynecologic Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA; Department of Obstetrics and Gynecology, Duke University Medical Center, 10 Duke Medicine Circ Durham, NC, 27710, USA", "Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, 1919 Old Spanish Trl, Houston, TX, 77054, USA; Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court, Aurora, CO, 80045, USA" ], "article_type": "research article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Ashley Chavana" }, { "affs": [ 1 ], "name": "Madeline Flanagan" }, { "affs": [ 1 ], "name": "Amir Owrangi" }, { "affs": [ 1 ], "name": "Shelly Sharma" }, { "affs": [ 2 ], "name": "Claire Hoppenot" }, { "affs": [ 2 ], "name": "Jan Sunde" }, { "affs": [ 2 ], "name": "Anthony B. Costales" }, { "affs": [ 3 ], "name": "Spoorthi Kamepalli" }, { "affs": [ 2 ], "name": "Tracilyn Hall" }, { "affs": [ 4 ], "name": "Michelle Ludwig" } ], "bibtex": "https://research.draconitic.com/paper/cwjy1qhc8hcmq.bib", "cited_by": 0, "doi": "10.1016/j.gore.2026.102231", "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2352578926002110", "id": "cwjy1qhc8hcmq", "issns": [ "2352-5789" ], "landing_url": "https://doi.org/10.1016/j.gore.2026.102231", "language": "en", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research Report" ], [ "lcc", "RC254-282" ], [ "lcc", "RG1-991" ], [ "openalex", "2729|Endometrial and Cervical Cancer Treatments" ] ], "openalex": "W7221727809", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13716993/pdf/?tool=EBI", "pmcid": "PMC13716993", "pmid": "42959201", "published": "2026-10-13", "publisher": "Elsevier", "ris": "https://research.draconitic.com/paper/cwjy1qhc8hcmq.ris", "sources": [ { "first_seen": "2026-10-30T13:43:36Z", "native_id": "c319ccc9b72a4471b6f5e00c6d5c069b", "source": "doaj", "url": "https://doi.org/10.1016/j.gore.2026.102231" }, { "first_seen": "2026-10-31T00:20:38Z", "native_id": "PMC:PMC13716993", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13716993" }, { "first_seen": "2026-10-31T12:21:46Z", "native_id": "MED:42959201", "source": "europepmc", "url": "https://europepmc.org/article/MED/42959201" }, { "first_seen": "2026-11-02T12:21:23Z", "native_id": "PMC13716993", "source": "pmc", "url": "https://doi.org/10.1016/j.gore.2026.102231" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2729|Endometrial and Cervical Cancer Treatments", "subfield": "reproductive-child" } ], "title": "Real-world experience with INTERLACE-style induction chemotherapy: Tumor regression and MRI-guided brachytherapy in locally advanced cervical cancer", "title_text": "Real-world experience with INTERLACE-style induction chemotherapy: Tumor regression and MRI-guided brachytherapy in locally advanced cervical cancer", "type": "peer-reviewed", "updated_at": "2026-11-02T12:21:23Z", "url": "https://research.draconitic.com/paper/cwjy1qhc8hcmq", "venue": "Gynecologic Oncology Reports", "versions": [] }