Abstract: Objective: To explore the clinical characteristics and the effects of combined therapy for primary esophageal small- cell carcinoma (PESC). Methods: Clinical data of 50 patients with PESC were analyzed, among which 16 were treated with radiotherapy or chemotherapy alone, 11 were treated with surgery alone, 17 were treated with postoperative radio- chemotherapy and 6 were treated with preoperative chemotherapy. The median survival time was investigated. Results: The overall excision rate was 85.2%, with 2 cases of operative mortality. The median survival time for patients who received combined radio- chemotherapy, simple surgery, postoperative chemotherapy with or without radiotherapy and preoperative chemotherapy was 7.2, 11, 16 and 22 months, respectively. Conclusions: Primary esophageal small- cell carcinoma is a systemic disease with high malignancy. Combined therapy should be applied to prolong patient life. Preoperative chemotherapy is highly recommended.