Local and systemic treatment in small cell carcinoma of the esophagus

Primary small cell carcinoma of the esophagus is a rare and aggressive dise ase. We report on our experience with two patients having a small cell canc er of the esophagus, being treated with photodynamic therapy combined with irradiation and induction-chemotherapy as well as a review of literature. B oth patients were admitted with severe dysphagia, weight loss and a Karnovs ky performance status of 90. Diagnostic work-up revealed tumor-stenosis in the proximal third in one and in the distal third in the other case. Clinic al staging showed T4N2M0 and T3N2M0, pure small cell carcinoma. Due to dysp hagia and lymph node enlargement, local and systemic therapy were considere d as first-line treatment. Restaging after three cycles of induction-chemot herapy revealed partial response in both cases. Esophagectomy as a second-l ine treatment was considered. However, in the preoperative period, one pati ent developed motorical aphasia. The CT-scan of the brain showed multiple b rain metastases. External beam irradiation and further chemotherapy was ini tiated. The patient died 12 months after admission. The other patient revea led anatomical inoperability at the staging laparoscopy. External beam irra diation and a second session of PDT was performed. The patient is still ali ve, 12 months after his first admission. The biological behavior of this ag gressive disease and metastases in about 50% of patients at admission, as w ell as significant dysphagia makes combined systemic and local treatment ne cessary. Nevertheless, after reviewing the literature, esophagectomy and ad juvant chemotherapy may have an advantage pertaining to survival time when anatomical and functional operability is given.