title: Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma.
abstract: BACKGROUND
  This retrospective study evaluates the efficacy and safety of surgery and chemotherapy (S +CT) vs. radiotherapy and CT (RT+CT) in patients with limited stage small cell esophageal cancer (LS-SCEC).
  
  
  METHODS
  Patients included in analysis (from our hospital and the literature) were treated with S+CT or RT+CT between 1989 and 2012. The primary end point was overall survival (OS); secondary end points included tumor response and toxicity. Kaplan-Meier OS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS.
  
  
  RESULTS
  A total of 127 patients were included: 14 from our hospital and 113 from the literature. Fifty-four (43%) and 73 (57%) patients received S+CT or RT+CT, respectively. The median OS of all patients was 21.0 months. OS was longer for those who received RT+CT rather than S+CT (33.0 vs. 17.5 months, p=0.02), especially those with N1 disease. Uni- and multi-variate analyses showed tumor location (upper 1/3rd of esophagus) and type of treatment (S+CT) were poor prognostic factors of OS.
  
  
  CONCLUSIONS
  LS-SCEC patients treated with RT+CT had an improved OS compared to those treated with S+RT. Thus, RT+CT should be considered as a primary approach for these patients.
authors.affiliation: Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.
authors.forename: Mao-Bin
authors.initials: MB
authors.lastname: Meng
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Zaorsky
authors.forename: Chao
authors.initials: C
authors.lastname: Jiang
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Tian
authors.forename: Huan-Huan
authors.initials: HH
authors.lastname: Wang
authors.forename: Chun-Lei
authors.initials: CL
authors.lastname: Liu
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Tao
authors.forename: Yao
authors.initials: Y
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Qing-Song
authors.initials: QS
authors.lastname: Pang
authors.forename: Lu-Jun
authors.initials: LJ
authors.lastname: Zhao
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Yuan
authors.forename: Wang
authors.initials: W
authors.lastname: Ping
mesh_terms: D000328:Adult; D000368:Aged; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies