There are positive clinical results of simultaneous radiotherapy and chemotherapy for esophageal cancer in foreign countries. In order to better improve the efficacy, more research has been conducted on the treatment method of preoperative concurrent radiotherapy followed by surgery, and some studies have obtained preliminary results on the application of accelerated hyper-segmentation radiotherapy combined with chemotherapy for esophageal cancer. Only 10-15% of patients with locally advanced esophageal cancer treated with surgery or radiation alone can achieve long-term tumor-free survival, and studies on the combination of radiotherapy and chemotherapy for esophageal cancer began in the 1970s, with encouraging preliminary results. In order to obtain better efficacy, people are studying the integrated therapy combining radiotherapy and surgery at the same time. 1.Simultaneous radiotherapy alone Statistics show that the local control and distant metastasis control in the simultaneous radiotherapy group are better than that in the radiotherapy group alone. Based on the results of this study, concurrent radiotherapy has become the standard treatment for inoperable esophageal cancer patients in the United States, Europe and Japan. Simultaneous radiotherapy can significantly improve the 1-year survival rate and 2-year survival rate, and the treatment toxicity is increased but tolerable. Therefore, it is considered that simultaneous radiotherapy and chemotherapy are best for non-surgical treatment of esophageal cancer patients. 2. Preoperative concurrent radiotherapy plus surgery The treatment method of preoperative concurrent radiotherapy followed by surgical resection has been published in more clinical studies in recent years. In general, the chemotherapy regimen used in preoperative concurrent radiotherapy studies is still mostly fluorouracil + cisplatin, and the radiotherapy dose is mostly selected at 40-45 Gy. More than 74% of patients can achieve surgical resection of the lesion, and the 5-year survival rate can reach 40%; the long-term survival rate of patients with complete remission of pathology after preoperative radiotherapy and surgery is higher, and the 3-year survival rate can reach 88%, and the 5-year survival rate can reach 67%. The long-term survival rate was 88% at 3 years and 67% at 5 years. Although the toxicity of concurrent radiotherapy increases and postoperative complications increase, the surgical mortality rate is not high and the treatment toxicity is still acceptable. 3, three-step treatment strategy The long-term survival rate of patients with complete remission of pathology after preoperative concurrent radiotherapy is significantly higher, and the main reason for treatment failure is distant metastasis. Some foreign researchers have tried to add induction chemotherapy before preoperative concurrent radiotherapy to improve the efficacy, and some scholars call this “induction chemotherapy-preoperative concurrent radiotherapy-surgical treatment” sequential treatment method a three-step treatment strategy. Although long-term survival results are not yet available, the study has initially shown that the three-step treatment strategy can improve the pathological complete remission rate and is a promising treatment option. 4.Conclusion With the improvement of comprehensive treatment level of esophageal cancer, preoperative simultaneous radiotherapy will become an important direction of research. The combination of simultaneous radiotherapy and surgery can become a more promising treatment method.