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Small Cell Cancer of the Oesophagus - A network series

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Purpose: Small Cell Carcinoma (SmCC) is a rare and aggressive subtype of oesophageal cancer. This retrospective review evaluated outcomes to guide future treatment decisions.

Case notes were reviewed for patients with SmCC of the oesophagus in Leeds Cancer Centre between 1991-2016. Staging was based on the Veterans Administration Lung study group system: Limited Disease (LD): tumour contained within a localised anatomic region, with/without involved regional lymphadenopathy; Extensive Disease (ED): tumour outside the locoregional boundaries.
Of 57 identified cases, median follow-up was 22.4 months and median survival (MS) was 10.4 months. 12 patients received chemotherapy alone, 18 sequential chemo-radiotherapy, 7 concurrent chemo-radiotherapy and 10 received no active treatment. Chemotherapy regimens were primarily platinum based. Radiotherapy doses ranged from 20Gy/5# - 50Gy/25#.
Amongst 23 patients with LD, MS was 15.1 months and 1 year survival was 60%. MS for those who received chemotherapy alone, radiotherapy alone, concurrent chemo-radiotherapy and sequential chemo-radiotherapy was 8.4 months, 5.8 months, not yet reached and 20.1 months respectively (p=non-significant).
Amongst 29 patients with ED, MS was 5.2 months and 1 year survival was 26%. MS for those who received no treatment, chemotherapy alone, radiotherapy alone and sequential chemo-radiotherapy was 1 month, 4.5 months, 3.6 months and 16.2 months respectively (p=0.001).

Either sequential or concurrent chemo-radiotherapy are acceptable treatments for LD. In patients with ED, there was a survival advantage from the addition of radiotherapy to chemotherapy, similar to evidence in ED small cell lung cancer. This requires further investigation in larger series.
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