Small Cell Carcinoma Esophagus: Experience of an Indian Tertiary Cancer Center

Background: Small cell carcinoma of the esophagus (SCCE) is a rare and aggressive tumor with no established standard treatment.Methods: This is a retrospective study of adult patients with histologically proven SCCE registered between February 2011 and March 2020 at Tata Memorial Hospital in Mumbai.Results: There were 56 patients with 29(51.8%) having limited-stage disease (LD) and 27(48.2%) having extensive-stage disease (ED). The median age was 58(IQR 51-65) years, 57.1% were men, 40% were smokers. Amongst LD-SCCE patients, 23 underwent local therapy i.e. radiation (19, 65.5%), surgery (4, 13.8%) and 27 received chemotherapy in neoadjuvant (23, 79.3%), concurrent (18, 62.1%) and adjuvant (4,13.8%) settings. Total 19 ED-SCCE patients (70.4%) received chemotherapy. Prophylactic cranial irradiation (PCI) was delivered to 11(37.9%) and 7(25.9%) patients with LD-SCCE and ED-SCCE, respectively. Significant grade ≥3 chemo-toxicities in patients with LD-SCCE and ED-SCCE included febrile neutropenia in 33.3% and 23.5%, anemia in 9.5% and 17.6%, and dyselectrolytemia in 14.3% and 11.8%, respectively. The median overall survival (OS) in LD-SCCE and ED-SCCE were 22.9 (95% CI 1.8-44.1) months and 11.8 (95% CI 7.3-16.4) months, respectively. Age <60years (p=0.004) and tumor epicenter in lower third esophagus (p=0.002) were good prognostic factors for OS in LD-SCCE and ED-SCCE patients respectively. The incidence of brain metastasis was low, both at presentation (1/27, 3.7%) and at relapse (5/56, 8.9%).Conclusion: Although the median overall survival of LD-SCCE is better than ED-SCCE, it is still under 2 years. Brain metastases are uncommon and PCI can be avoided with close clinico-radiological follow up.