Small cell carcinoma oftheoesophagus: report ofthree casesandreview of published cases

Small cell carcinoma oftheoesophagus is araretumourwithapoorprognosis. Thisreport presents evidence favouring chemotherapy asthe primary treatment. Since itwasfirst described in1952byMcKeown,' primary small cell carcinoma oftheoesophagus hasbeenreported with increasing frequency, andmorethan 80cases have now beenpublished. Thenatural history andmedian survival are reported tobeverysimilar tothatofsmall cell lung carcinoma.2 We present three casesandevidence from published reports indicating that this isachemosensitive and radiosensitive disease. Casereports CASE1 A 70yearoldwoman,a non-smoker, presented with increasing dysphagia ofnine months' duration. Endoscopy showed apolypoid, circumferential tumour at25cm,extend- ingdistally for7cm.Abiopsy specimen showed undifferen- tiated small cell carcinoma. Bronchoscopy andultrasound andisotope scanning oftheliver showed nothing abnormal. Shewastreated with radical radiotherapy totheoesophagus with acomplete symptomatic response. Twomonths later she haddeveloped liver metastases andwasbedboundwith nausea andlethargy. Shewastreated withfourcycles of chemotherapy (table) andimproved symptomatically. She diedtwomonths later (nine months after diagnosis) with widespread metastatic disease. CASE2