At diagnosis, nearly 50% of patients with carcinoma of the esophagus have a metastatic disease. Less than 60% of patients with locoregional disease can undergo a curative resection. Surgical principles include a wide resection of the primary tumor, including resection margins of 5 cm or more, plus regional lymphadenectomy. Radiotherapy alone can be considered for palliation in patients with locoregional disease who are medically unsuitable for surgery and in patients with contraindication for chemotherapy. The median length of survival is approximately 12 months. Effectiveness of chemoradiotherapy has been studied in randomized trials in patients with locoregional carcinoma (stage I-III). Chemoradiotherapy should include 50 to 60 Gy of radiotherapy plus concurrent chemotherapy with 5-fluorouracil (5-FU) plus cisplatin. Chemoradiotherapy is now an established alternative to surgical therapy (predominantly in patients with squamous cell carcinoma). In patients treated with chemoradiotherapy, a follow up endoscopy of the upper gastrointestinal tract 4 to 6 weeks after its completion is recommended. If a complete remission can be confirmed, patients are observed or offered esophagectomy. Patients with unresectable (T4) carcinoma can be treated with radiotherapy plus concurrent chemotherapy and those with adenocarcinoma of the distal esophagus with positive nodes should receive adjuvant postoperative radiotherapy and chemotherapy with 5-FU plus cisplatin.