title: Evaluation of unusual and highly aggressive variant of endometrium cancer: nonendometrioid endometrium carcinoma of the uterus.
abstract: OBJECTIVE
  To evaluate the survival and treatment outcomes of patients with nonendometrioid endometrium carcinoma after postoperative radiotherapy.
  
  
  METHODS
  The records of 94 patients treated with postoperative radiotherapy (RT) between January 2005 and December 2011 were retrospectively reviewed. Postoperative RT was delivered with a dose of 45-50.4 Gy with 1.8 Gy daily fractions and brachytherapy was added to external RT for 62 patients with a dose of 3 × 6 Gy. Median follow-up time was 35 months (range 6-95 months).
  
  
  RESULTS
  Median age was 63 years (range 43-83 years) and lymph node metastasis (LNM) was positive in 15 (16.0%) patients. The stage distribution of the patients was as follows: stage I, 58 (61.7%); stage II, 16 (17.0%); stage III, 18 (19.1%); stage IV, 2 (2.2%). Five-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates were 92.3%, 68.2%, and 78.6%, respectively. In univariable analysis, it was determined that the factors affecting OS rates were stage (p = 0.003), presence of LNM (p = 0.003), and presence of lymphovascular space invasion (LVSI) (p = 0.007); factors affecting DFS rates were stage (p = 0.019), presence of LVSI (p = 0.002), and having LNM (p = 0.049); and the factor affecting LRC rates was tumor size (>5 cm) (p = 0.011). In subgroup analyses, among all stage I patients, the DFS rates were lower for those with histologic grade 3 tumors and more than ½ myometrial invasion.
  
  
  CONCLUSIONS
  Due to its rarity, the prognostic factors and outcomes of nonendometioid endometrium carcinoma are not fully understood. In our analysis, stage, LNM, and presence of LVSI were found to be the most important prognostic factors. In order to tailor the optimal treatment strategy, prospective studies are needed.
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Sert
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Yılmaz
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Senem
authors.initials: S
authors.lastname: Alanyalı
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Arif
authors.initials: A
authors.lastname: Aras
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ozsaran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies