© 2015 Wichtg Publishing TJ ISSN 0300-8916 Tumori 2017; 103(6): 551-556 ORIGINAL RESEARCH ARTICLE nosis (1). Other less common nonendometriod carcinoma histologies are mucinous and epidermoid cancers. Nonendometrioid type endometrium carcinomas are rare- ly seen. Therefore, standard treatment approaches have not been defned by randomized trials. Moreover, there is no clear consensus in evidence-based treatment guidelines. Surgery is the mainstay of treatment for endometrium cancers but the extent of the surgery difers between the 2 types of endometrium cancers. The need for adjuvant treat- ment is based on the depth of myometrial invasion, histologic grade (HG), the presence of lymphovascular space invasion (LVSI), stage, and lymph node (LN) status. These risk factors are not fully reliable for nonendometriod carcinomas. Distant metastasis rates can be high in patents presentng with an early-stage endometrium cancer. Surgical approaches should be utlized as in ovarian cancers due to their aggressive be- havior. Intra-abdominal microscopic foci can be detected at rates up to 20%-25% in postoperatve evaluatons of stage IA disease (2). For early stage (stage I, II) nonendometrioid endometrium carcinomas, external and/or intracavitary radiotherapy (RT) DOI: 10.5301/tj.5000404 Evaluaton of unusual and highly aggressive variant of endometrium cancer: nonendometrioid endometrium carcinoma of the uterus Fatma Sert, Ugur Yılmaz, Senem Alanyalı, Arif Aras, Zeynep Ozsaran Department of Radiaton Oncology, Ege University Faculty of Medicine, Izmir - Turkey Introducton Endometrial cancer, the most common gynecologic malig- nancy in developed countries, is divided into 2 subtypes: type 1 and type 2. Type 1 endometrium cancer consttutes 80% of patents and is called endometrioid carcinoma. These tumors are associated with estrogen hormone and have good prog- nosis. Type 2 endometrium cancers are composed of poorly diferentated subtypes like clear cell and serous carcinomas, independent from estrogen hormone, and have poor prog- AbSTRACT Aims: To evaluate the survival and treatment outcomes of patents with nonendometrioid endometrium carci- noma afer postoperatve radiotherapy. Methods: The records of 94 patents treated with postoperatve radiotherapy (RT) between January 2005 and December 2011 were retrospectvely reviewed. Postoperatve RT was delivered with a dose of 45-50.4 Gy with 1.8 Gy daily fractons and brachytherapy was added to external RT for 62 patents with a dose of 3 × 6 Gy. Median follow-up tme was 35 months (range 6-95 months). Results: Median age was 63 years (range 43-83 years) and lymph node metastasis (LNM) was positve in 15 (16.0%) patents. The stage distributon of the patents 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%, respectvely. In univariable analysis, it was determined that the factors afectng OS rates were stage (p = 0.003), presence of LNM (p = 0.003), and presence of lymphovascular space invasion (LVSI) (p = 0.007); factors afectng DFS rates were stage (p = 0.019), presence of LVSI (p = 0.002), and having LNM (p = 0.049); and the factor afectng LRC rates was tumor size (>5 cm) (p = 0.011). In subgroup analy- ses, among all stage I patents, the DFS rates were lower for those with histologic grade 3 tumors and more than ½ myometrial invasion. Conclusions: Due to its rarity, the prognostc factors and outcomes of nonendometoid endometrium carcinoma are not fully understood. In our analysis, stage, LNM, and presence of LVSI were found to be the most important prognostc factors. In order to tailor the optmal treatment strategy, prospectve studies are needed. Keywords: Clear cell endometrium carcinoma, Nonendometriod endometrium carcinoma, Radiotherapy, Serous papillary endometrium carcinoma, Type 2 endometrium carcinoma Accepted: July 9, 2015 Published online: September 17, 2015 Corresponding author: Fatma Sert, MD Department of Radiaton Oncology Ege University Faculty of Medicine Izmir, Turkey fatma.sert@ege.edu.tr