Real-world experience with INTERLACE-style induction chemotherapy: Tumor regression and MRI-guided brachytherapy in locally advanced cervical cancer
5 affiliations
- 1Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, 1919 Old Spanish Trl, Houston, TX, 77054, USA; Corresponding authors.
- 2Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, 1919 Old Spanish Trl, Houston, TX, 77054, USA
- 3Department of Gynecologic Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- 4Department 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
- 5Department 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
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.
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BibTeX
@article{chavana2026realworld,
title = {{Real-world experience with INTERLACE-style induction chemotherapy: Tumor regression and MRI-guided brachytherapy in locally advanced cervical cancer}},
author = {Ashley Chavana and Madeline Flanagan and Amir Owrangi and Shelly Sharma and Claire Hoppenot and Jan Sunde and Anthony B. Costales and Spoorthi Kamepalli and Tracilyn Hall and Michelle Ludwig},
journal = {Gynecologic Oncology Reports},
year = {2026},
month = oct,
doi = {10.1016/j.gore.2026.102231},
url = {https://doi.org/10.1016/j.gore.2026.102231},
note = {CC BY},
}
RIS
TY - JOUR
TI - Real-world experience with INTERLACE-style induction chemotherapy: Tumor regression and MRI-guided brachytherapy in locally advanced cervical cancer
AU - Ashley Chavana
AU - Madeline Flanagan
AU - Amir Owrangi
AU - Shelly Sharma
AU - Claire Hoppenot
AU - Jan Sunde
AU - Anthony B. Costales
AU - Spoorthi Kamepalli
AU - Tracilyn Hall
AU - Michelle Ludwig
PY - 2026
DA - 2026/10/13
JO - Gynecologic Oncology Reports
DO - 10.1016/j.gore.2026.102231
UR - https://doi.org/10.1016/j.gore.2026.102231
AB - 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.
SN - 2352-5789
ER -