During the past decade, treatment outcomes for patients with cancer of the esophagus have improved greatly. Palliation of dysphagia and odynophagia can be achieved with radiation therapy alone, but palliation may be more consistent and durable if radiation is combined with chemotherapy. Patients with inoperable tumors can be cured with concurrent chemotherapy and moderate-dose radiation therapy. The addition of esophageal brachytherapy to external irradiation and concurrent chemotherapy is associated with a high risk for complications. Surgical techniques and support have improved such that mortality rates after esophagectomy have decreased dramatically. However, results of surgical treatment for esophageal cancer remain disappointing. It may be advantageous to use concurrent chemoradiation therapy before esophageal resection, but further studies are needed. Most of the studies comparing chemoradiation therapy with and without esophageal resection have not shown a survival benefit from the addition of surgery. Advances in radiation therapy techniques have, however, provided a means to increase the therapeutic ratio in the multimodality treatment of esophageal cancer.