Esophageal cancer is one of the common malignant tumors in the world. It is estimated that more than 300,000 people die from esophageal cancer every year, ranking the 6th cause of cancer death in the world. The number of esophageal cancer patients in China accounts for more than 50% of the world, ranking the 4th cause of cancer death in China, which is a serious threat to the health of our people. The annual number of deaths from esophageal cancer in China is 211,000 cases, which is more than half of the total number of deaths from esophageal cancer worldwide. Although certain progress has been made in all aspects of esophageal cancer treatment in recent years, the overall survival rate has not yet been significantly improved. According to the experts, the diagnosis and treatment of esophageal cancer have entered a bottleneck period, and how to break through is the key to improve the survival of esophageal cancer patients in the future. Prevention and early diagnosis of esophageal cancer Prevention and early diagnosis of esophageal cancer are still in the research stage, and there are no research results that can be applied to clinical practice. Prof. Zhang Xiaodong from Peking University School of Clinical Oncology said that in Japan, upper gastrointestinal endoscopy is a routine screening method for esophageal cancer, but early stage esophageal cancer only accounts for 20%, while locally progressive and advanced stage esophageal cancer still accounts for 80%. In our country, the early diagnosis rate of esophageal cancer is even lower, and the incidence of progressive esophageal cancer is even higher. Therefore, we are facing the problem of how to treat more than 80% of patients with locally progressive and advanced esophageal squamous cancer. III. Treatment of esophageal cancer Surgical esophageal cancer treatment means include surgery, radiotherapy and chemotherapy. At present, radical surgery is the main treatment for clinically diagnosed early-stage esophageal cancer. In recent years, improved and optimized surgical methods have only reduced the incidence of postoperative complications and surgery-related mortality, resulting in survival benefits for patients who can undergo surgery, but most patients with esophageal cancer are already in the middle and advanced stages when diagnosed clinically, and the efficacy of surgical treatment alone is poor. Therefore, the National Comprehensive Cancer Network (NCCN) guidelines recommend surgery as a single treatment modality only for patients without lymph node metastases in stage T1. Radiotherapy has been explored in the past 10 years with negative results for changing radiotherapy modalities for esophageal cancer, improving only patient tolerance and offering no advantage in improving survival. A study from the Cancer Hospital of the Chinese Academy of Medical Sciences found no significant difference in 5-year survival in the overall population after preoperative and postoperative radiotherapy compared with surgery alone, but subgroup analysis showed a meaningful improvement in 5-year survival in stage III patients with postoperative radiotherapy. Thus, surgery combined with radiotherapy is a treatment option for patients with lymph node-positive esophageal squamous carcinoma, but overall survival is still unsatisfactory and far from meeting the treatment expectations of esophageal squamous carcinoma, and there is less and less room for further improvement of surgery and radiotherapy methods with the development of technology. Currently, adjuvant chemotherapy is recommended for patients with stage II or higher esophageal cancer with high-risk recurrence factors, while palliative chemotherapy is recommended for advanced recurrent metastatic esophageal cancer. Effective cytotoxic drugs for esophageal cancer monotherapy include BLM, PYM, MMC, DDP, NDP, LBP, MGAG, 5-FU, MTX, PTX, TXT, NVB, VDS and CPT-11, with single-agent efficiency of 20%-30%. Although squamous esophageal cancer is more sensitive to most drugs than adenocarcinoma, the remission period is shorter. Therefore, combination chemotherapy regimens are mostly used for esophageal cancer chemotherapy. Although there is no accepted standard chemotherapy regimen, platinum-containing DDP + 5-FU or DDP + paclitaxel regimens are recognized as the basic first-line treatment for esophageal cancer. Although the development of new cytotoxic drugs has progressed rapidly and their recent efficacy in the treatment of esophageal squamous carcinoma has been greatly improved, the application of cytotoxic drugs alone in the treatment of esophageal squamous carcinoma is not advocated, even for patients with advanced systemic multiple metastases, the timely combination of local radiotherapy is meaningful for their improvement in quality of life. On the other hand, the concept of considering other local treatment options after chemotherapy has led to disease progression is increasingly questionable and ethically impermissible, both in clinical treatment and research. Studies combining chemotherapy with other treatment modalities, such as preoperative neoadjuvant chemotherapy and postoperative adjuvant chemotherapy, are also underway in various countries around the world, but unfortunately the results still vary widely due to the lack of differentiation between different pathological types, sites, etc., making them inconclusive even today. Moreover, since most of these studies were conducted abroad, the sample size of esophageal squamous carcinoma in the study is small and the results have no clinical guidance. IV. Summary In conclusion, nowadays, various single treatment methods are limited in improving the efficacy and survival of esophageal squamous carcinoma, and how to further improve the quality of life and prolong the survival of patients is the key direction of clinical research. From the results of domestic and international studies at this stage, the most definite and feasible approach is comprehensive and multidisciplinary treatment, and the rational arrangement and application of not many therapies is urgently needed to be implemented. Whether in China or other Asian and Western countries, the concept of comprehensive treatment is increasingly recognized and promoted, and the treatment of esophageal squamous carcinoma relies more on this treatment model.