Salma Ichou, Imane Hassnaoui, Amine Lachgar, Karima Nouni, Hanan ElKacemi, Tayeb Kebdani, Khalid Hassouni
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 8
Date of Publication: 2026/08/02
Background: Primary small-cell neuroendocrine carcinoma of the esophagus is a rare and aggressive malignancy, accounting for less than 3% of esophageal cancers. Its biological behavior resembles that of small-cell lung cancer, with rapid growth, early lymphatic spread, and a poor prognosis. No standardized treatment exists, and management in elderly patients is particularly challenging given the balance between disease control and treatment-related toxicity.
Case Presentation: An 85-year-old man with a history of hypertension and chronic tobacco exposure presented with progressive dysphagia, vomiting, and a 9-kg weight loss over one month. Endoscopy revealed a circumferential ulcerated and budding lesion of the thoracic esophagus. Histopathology and immunohistochemistry confirmed primary small-cell neuroendocrine carcinoma (synaptophysin- and CD56-positive, Ki-67 approaching 100%). Staging with computed tomography and ¹⁸F-FDG PET/CT showed locally advanced, nonmetastatic disease (cT3N1M0, clinical stage III). Given the patient's preserved performance status despite advanced age, he received three cycles of induction carboplatin–etoposide chemotherapy followed by definitive concurrent chemoradiotherapy (50.4 Gy in 28 fractions with concurrent platinum–etoposide). Treatment was overall well tolerated, although the patient required a two-week hospitalization for management of dysphagia to liquids and odynophagia. At one year of follow-up, disease control remained favorable.
Conclusion: This case illustrates that individualized, multimodal treatment combining induction chemotherapy and definitive chemoradiotherapy can be safely delivered and achieve favorable outcomes in a very elderly patient with locally advanced esophageal small-cell neuroendocrine carcinoma, provided that performance status and patient preferences are carefully considered.
Case report; Chemoradiotherapy; Elderly; Esophageal neoplasms; Induction chemotherapy; Neuroendocrine carcinoma; Small-cell carcinoma
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