Concurrent chemoradiotherapy (CCRT) is effective in the treatment of locally advanced cervical squamous cell carcinoma (SCC). However, whether treatment outcomes of cervical adenocarcinoma are equivalent to SCC after CCRT has been a topic of debate. Medical records of cervical cancer patients treated with definitive radiotherapy or CCRT in our institute from January 2011 to December 2014 were reviewed. Patients were treated with intensity modulated radiation therapy combined with intracavitary brachytherapy. Weekly cisplatin was the first line regimen of concurrent chemotherapy. The treatment outcomes of patients with SCC and adenocarcinoma were compared with a multivariate Cox regression model, and log-rank method before and after propensity score matching (1:1). A total of 815 patients with stage IB-IVA cervical cancer were included, with 744 patients in the SCC group and 71 patients in adenocarcinoma group. The median follow-up period was 36.2 months (range, 1.0–76.2 months). The 3-year overall survival (OS), disease-free survival (DFS), pelvic control and distant control rates of patients in the SCC group and adenocarcinoma group were 85.2 and 75.4% (p = 0.005), 77.5 and 57.3% (p < 0.001), 89.0 and 74.0% (p = 0.001) and 86.0 and 74.4% (p = 0.011), respectively. After multivariate analysis, histology was an independent factor of OS (p = 0.003), DFS (p < 0.001), pelvic control (p = 0.002) and distant control (p = 0.003). With propensity score matching, 71 pairs of patients were selected. After matching, the OS (p = 0.017), DFS (p = 0.001), pelvic control (p = 0.015) and distant control (p = 0.009) of patients with adenocarcinoma were poorer than those of patients with SCC. In subgroup analysis, patients with adenocarcinoma had significantly worse OS and DFS compared with patients with SCC, regardless of treatment with radiotherapy alone or CCRT. The present study demonstrated that patients with adenocarcinoma of the cervix had poorer OS and DFS than patients with SCC, regardless of treatment with radiotherapy alone or CCRT. New treatment approaches should be considered for cervical adenocarcinoma.

We introduced and evaluated an end-to-end organs-at-risk (OARs) segmentation model that can provide accurate and consistent OARs segmentation results in much less time. We collected 105 patients' Computed Tomography (CT) scans that diagnosed locally advanced cervical cancer and treated with radiotherapy in one hospital. Seven organs, including the bladder, bone marrow, left femoral head, right femoral head, rectum, small intestine and spinal cord were defined as OARs. The annotated contours of the OARs previously delineated manually by the patient's radiotherapy oncologist and confirmed by the professional committee consisted of eight experienced oncologists before the radiotherapy were used as the ground truth masks. A multi-class segmentation model based on U-Net was designed to fulfil the OARs segmentation task. The Dice Similarity Coefficient (DSC) and 95th Hausdorff Distance (HD) are used as quantitative evaluation metrics to evaluate the proposed method. The mean DSC values of the proposed method are 0.924, 0.854, 0.906, 0.900, 0.791, 0.833 and 0.827 for the bladder, bone marrow, femoral head left, femoral head right, rectum, small intestine, and spinal cord, respectively. The mean HD values are 5.098, 1.993, 1.390, 1.435, 5.949, 5.281 and 3.269 for the above OARs respectively. Our proposed method can help reduce the inter-observer and intra-observer variability of manual OARs delineation and lessen oncologists' efforts. The experimental results demonstrate that our model outperforms the benchmark U-Net model and the oncologists' evaluations show that the segmentation results are highly acceptable to be used in radiation therapy planning.

We aimed to analyze the outcomes of hypofractionated high-energy electron beam radiotherapy for the treatment of keloids. From February 1998 to January 2012, 568 patients with a total of 834 keloids underwent radiotherapy: 826 lesions with postoperative radiotherapy, and 36 with skin-grafting. Lesion size was >5 cm in 335 keloids. An electron-beam of 6 or 7 MeV was used, with a total dose of 18 Gy (two fractions with a 1-week interval) covering the lesion with a 1-cm margin. The time between surgery and radiotherapy was 24–48 h. Skin-grafted patients underwent radiotherapy 10–15 days after the operation. The median follow-up was 40 months (range: 12–160 months). The local control rate was 88.25% (736/834). The relapse rate was 9.59% (80/834), and the time to relapse was 6–28 months (median: 12 months). Univariate analyses showed that gender, age, keloid size, keloid site, skin grafting, and operation-to-irradiation interval influenced the local control rate. Multivariate analysis showed that the relapse rate was correlated with gender ( P = 0.048), age ( P < 0.01), operation-to-irradiation interval ( P < 0.01), keloid site ( P < 0.01), surgical method ( P = 0.04) and keloid size ( P < 0.02). Adverse effects were observed in 9.83% (82/834). No radiation-induced cancers were observed. Hypofractionated high-energy electron beam radiotherapy for keloids yielded excellent outcomes, especially in cases without skin grafting. Early postoperative radiotherapy with limited hypofractionation could be a good choice for keloid treatment.

Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial. We retrospectively analyzed the efficacy and tolerance of radical radiotherapy (RT) or CCRT in elderly cervical cancer patients and performed comparisons between them. We retrospectively analyzed the elderly cervical cancer patients (≥70 years old) treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel. Seventy-three patients were eligible for this study. Twenty-one(28.8%) and 52(71.2%) patients suffered with FIGO stage IB-IIA and IIB-IVA disease, respectively. Twenty-four (32.9%) patients received CCRT. The median duration of follow-up was 32.4 months (4.8–118.8 months). The 3-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were 64.9%, 67.8% and 66.5%, respectively. By multivariate analysis, CCRT was a significant predictive factor of OS(p = 0.023, 95% confidence interval [CI]: 1.172–8.860), CSS(p = 0.031, 95% CI: 1.131–13.908)and DFS(p = 0.045, 95% CI: 1.023 ~ 6.430). The 3-year OS of patients received RT and CCRT were 54.3% and 83.1%, CSS were 56.8% and 87.1%, DFS were 57.6% and 83.3%. There was no treatment related death. Grade 3–4 acute hematological, gastrointestinal and urinary toxicity incidences were 31.5%, 19.1% and 12.3%, respectively. For grade 3–4 chronic gastrointestinal and genitourinary toxicities, the incidences were 4.1% and 2.7%, respectively. Compared with RT, CCRT was related with high grade 3–4 hematological toxicity (16.3% and 62.5% respectively, p < 0.001), respectively. However, acute nonhematological toxicity and chronic toxicity were not significantly different. Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

The diagnostic power of CT or MRI on the lymph node status was limited. Supplement measurements were needed to assist the diagnosis of lymph node metastasis. The SCCa was reported to be close related to lymph node status. But currently the clinical value of serum SCCa measurement in lymph node status has not been clearly defined. This meta-analysis was to investigate this topic on a large scale. Searching the Pubmed, Embase, Cochrane library, CNKI and Wanfang database for SCC-Ag/SCCA/SCC-antigen and cervical cancer/tumor/carcinoma/neoplasm published in any language from Jan 1 1990 to Aug 1 2017. QUADAS (quality assessment of diagnostic accuracy studies) was used to evaluate the quality of the articles. An eligible set of data should include true positive, true negative, false positive and false negative number. Every set of data was extracted and analyzed by STATA 14.0. The forest plot and bivariate boxplot were utilized to evaluate the heterogeneity. The funnel graph was used to test the publication bias. The SROC curve was draw via random effect model and HSROC model. 17 sets of data and 3985 patients were included for the diagnostic meta-analysis. There was heterogeneity, which was partially from SCCa cut-off value. The pooled sensitivity was 0.70 and specificity was 0.63. AUC was 0.73. Eight articles provided the relative risk value of lymphatic metastasis when SCCa increased. The relative risk of lymph node metastasis increased ranging from 2.3–40 as with different SCCa cut off value. The diagnostic value of SCCa for lymph nodal metastasis was medium and it was strongly related to lymph node status. Thus SCCa could assist imaging tests to detect lymph node metastasis. Besides, it was correlated with para-aortic lymph node metastasis.