Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma

Background: This retrospective study evaluates the efficacy and safety of surgery and chemotherapy (S + CT) vs. radiotherapy and CT (RT + CT) in patients with limited stage small cell esophageal cancer (LS-SCEC). Patients and methods: Patients included in analysis (from our hospital and the literature) were treated with S + CT or RT + CT between 1989 and 2012. The primary end point was overall survival (OS); secondary end points included tumor response and toxicity. Kaplan-Meier OS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS. Results: A total of 127 patients were included: 14 from our hospital and 113 from the literature. Fifty-four (43%) and 73 (57%) patients received S + CT or RT + CT, respectively. The median OS of all patients was 21.0 months. OS was longer for those who received RT + CT rather than S + CT (33.0 vs. 17.5 months, p = 0.02), especially those with N1 disease. Uni- and multi-variate analyses showed tumor location (upper 1/3rd of esophagus) and type of treatment (S + CT) were poor prognostic factors of OS. Conclusion: LS-SCEC patients treated with RT + CT had an improved OS compared to those treated with S + RT. Thus, RT + CT should be considered as a primary approach for these patients.