Aims: Small cell esophageal carcinoma (SCEC) is a rare and highly aggressive malignancy characterised by a poor prognosis, particularly in patients with extensive disease. The effectiveness of incorporating radiotherapy to chemotherapy remains ambiguous. This study aimed to evaluate the survival benefits of chemoradiotherapy (CRT) compared to chemotherapy (CT) alone in patients with extensive-stage small cell esophageal carcinoma (ES-SCEC). Materials and methods: In this multicenter, retrospective study, 191 ES-SCEC patients treated across 15 Chinese institutions between April 2002 and November 2021 were included. Patients were stratified into two groups: CT (n = 108) and CRT (n = 83). Propensity score matching (PSM) was employed to balance baseline characteristics. Kaplan-Meier analysis was conducted to assess overall survival (OS) and progression-free survival (PFS). Results: Among the 191 ES-SCEC patients (73.8% male), tumours were predominantly located in the lower thoracic esophagus (46.1%). Oligometastasis occurred more frequently in the CRT group (84.3% vs 69.4%). The majority of patients received etoposide-platinum chemotherapy (78%), whereas conventional radiation (50-66 Gy) was utilised in 97.2% of cases for CRT. In the overall cohort, median OS was 12.6 months. The 1-, 3-, and 5-year OS rates are 53.1% (95% CI: 46.4-60.9), 5.6%(95%CI: 2.8-11.1), and 3.0% (95% CI: 0.9-9.3), respectively. No significant difference between CRTand CTgroups before (13.6 vs 11.5 months, P = .12) or after PSM (13.1 vs. 11.5 months, P = .25). However, T3-4N0-1M1 patients showed significantly improved OS (hazard ratio [HR = 0.47, 95% CI: 0.26-0.84, P = .011) and PFS (HR = 0.42, 95% CI: 0.23-0.77, P = .005) with CRT. CRT reduced locoregional recurrence (29.7% vs 58.2%) but increased grade >= 3 haematologic toxicity (leukopenia: 34.6% vs 15.4%). Multivariate analysis identified chemotherapy cycles (P < .01) and metastatic status (P = .002) as independent prognostic factors. Conclusion: Compared to chemotherapy alone, chemoradiotherapy offers relatively minimal therapeutic benefit for ES-SCEC patients, while it exhibits significant efficacy in the T3-4N0-1M1 subgroup. Further research is necessary to develop more effective treatment strategies for SCEC. (c) 2026 The Author(s). Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
[1]Univ Elect Sci & Technol China, Sichuan Canc Hosp & Inst, Sichuan Clin Res Ctr Canc, Sichuan Canc Ctr,Sch Med,Dept Radiat Oncol, Chengdu, Peoples R China.
[2]Univ Elect Sci & Technol China, Sichuan Canc Hosp & Inst, Radiat Oncol Key Lab Sichuan Prov, Sichuan Canc Ctr,Dept Radiat Oncol,Sichuan Clin Re, Chengdu, Peoples R China.
[3]Univ Elect Sci & Technol China, Sichuan Canc Hosp & Inst, Sichuan Clin Res Ctr Canc, Canc Ctr,Dept Thorac Surg, Chengdu, Peoples R China.
[4]Shandong First Med Univ, Shandong Canc Hosp & Inst, Shandong Acad Med Sci, Jinan, Shandong, Peoples R China.
[5]Sichuan Univ, West China Hosp, Canc Ctr, Dept Thorac Oncol, Chengdu, Peoples R China.
[6]Sichuan Univ, West China Hosp, Canc Ctr, Dept Radiat Oncol, Chengdu, Peoples R China.
[7]Henan Univ Sci & Technol, Anyang Canc Hosp, Dept Radiotherapy, Affiliated Hosp 4, Luoyang, Peoples R China.
[8]Shandong First Med Univ, Shandong Prov Hosp, Tai An, Peoples R China.
[9]Chinese Acad Med Sci & Peking Union Med Coll, Dept Radiat Oncol, Natl Clin Res Ctr Canc, Natl Canc Ctr,Canc Hosp, Beijing, Peoples R China.
[10]North Sichuan Med Coll, Dept Oncol, Affiliated Hosp, Nanchong, Peoples R China.
[11]Jining Med Univ, Affiliated Hosp, Jining, Peoples R China.
[12]Shandong Univ, Qilu Hosp, Jinan, Peoples R China.
[13]Jining First Peoples Hosp, Jining, Peoples R China.
[14]Tianjin Med Univ, Key Lab Canc Prevent & Therapy, Tianjins Clin Res Ctr Canc, Canc Inst & Hosp,Natl Clin Res Ctr Canc, Tianjin, Peoples R China.
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