Invited Commentary

Abstract

Kuo and colleagues [1Kuo C.H. Hsieh C.C. Chan M.L. et al.Small cell carcinoma of the esophagus: a report of 16 cases from a single institution and literature review.Ann Thorac Surg. 2011; 91: 373-379Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar] are to be commended on their management and reporting of 16 patients with small cell carcinoma (SCC) of the esophagus. As stated by the authors, this is a very rare disease entity, likely comprising no more than 1% of patients with esophageal cancer. Although a primary treatment strategy consisting of chemotherapy may be obvious for patients with advanced disease, the most appropriate strategy for patients with limited disease is less clear. The authors suggest that patients with limited, resectable SCC of the esophagus should be treated with surgical resection, followed by chemotherapy. They base this conclusion on their own series, in which 3 of 4 patients treated by this method had no evidence of disease at the time of the report, compared with 0 of 4 patients with limited disease treated by nonsurgical management. The results, although suggestive, need to be interpreted with caution. As with other reports in the literature pertaining to SCC of the esophagus, the opinion is based on a retrospective analysis of a highly selected cohort. In their series, it is not clear whether the patients with “limited” disease who did not undergo surgical resection were truly comparable with those undergoing resection, because no clinical staging is given regarding the N classification and local control by use of radiotherapy was suboptimal in that group. In particular, one might expect large variation in the degree of regional adenopathy between the groups at presentation. Patients who underwent surgical resection as primary therapy for this disease likely were diagnosed with SCC incidentally or presented without evidence of involved regional lymph nodes. Given that SCC is typically a systemic disease, a treatment algorithm based on neoadjuvant chemotherapy would seem prudent. In properly selected patients with limited disease, local control could then be obtained with either operation or radiotherapy. One would expect that this strategy would maximize the amount of chemotherapy delivered to these patients, which likely has the biggest effect on survival. In the very rare case of a patient with clinical T1 N0 SCC of the esophagus, primary surgical therapy may be appropriate. Small Cell Carcinoma of the Esophagus: A Report of 16 Cases From a Single Institution and Literature ReviewThe Annals of Thoracic SurgeryVol. 91Issue 2PreviewThe optimum treatment for small cell carcinoma of the esophagus (SCEC) has not been established. We reviewed our experience in the management of patients with SCEC. Full-Text PDF