Esophageal small cell carcinoma is a highly aggressive disease, and no effective treatment has yet been reported. We present here two cases of esophageal small cell carcinoma preoperatively treated with a combination of hyperthermia, irradiation, and an intravenous infusion of cis-diamminedichloroplatinum (CDDP). The first case concerned a 67-year-old Japanese woman. Hyperthermochemoradiotherapy (HCR) was performed before surgical treatment. A histopathologic study of the resected specimen showed no residual viable cancer cells either in the esophagus or in the dissected lymph node. The second case involved a 59-year-old Japanese man who received HCR therapy before surgical treatment. This patient survived for 33 months, the longest known period of survival for small cell carcinoma of the esophagus. These cases indicate that preoperative hyperthermochemoradiotherapy may be considered one promising adjuvant therapy alternative for this aggressive disease.