As a worldwide epidemic and with great geographical differences, esophageal cancer, with the fifth highest incidence rate and the fourth highest mortality rate of malignant tumors, has always been a thorny problem in oncology. The incidence and death of esophageal cancer in China account for more than half of the world. So far, except for early esophageal cancer, most of the esophageal cancers are still incurable and have poor prognosis. However, living up to the joint efforts of the oncology community, the diagnosis and treatment of esophageal cancer have made remarkable achievements in recent years, and the major advances in esophageal cancer in 2011 ASCO meeting and the latest update of NCCN guideline are summarized now. Progress of neoadjuvant therapy Recently, H. Hara of Japan conducted a feasibility study of neoadjuvant chemotherapy with docetaxel, cisplatin and 5-Fu (DCF) for stage II/III esophageal squamous carcinoma, which showed that the neoadjuvant DCF regimen was well tolerated and its anti-tumor efficacy had great potential. P.C. Thuss-Patience et al. from Germany reported a phase II AIO study of perioperative chemotherapy with docetaxel, cisplatin, and capecitabine (DCX) for gastroesophageal adenocarcinoma, which showed that DCX regimen could be safely used for the perioperative treatment of locally progressed adenocarcinoma of the esophagus, with a pCR rate of 13.7%, which was the highest in the comparative trials of three-agent chemotherapy. The 2011 NCCN Esophageal Cancer Guidelines for neoadjuvant radiotherapy have made the following adjustments. Additions: carboplatin + 5-Fu (grade 2B), oxaliplatin + docetaxel + capecitabine (grade 2B). Level of evidence changes: paclitaxel + carboplatin is grade 2B-1; cisplatin + 5-Fu class (5-Fu or capecitabine) is grade 2A-1; oxaliplatin + 5-Fu class is grade 2B-2A; and paclitaxel + cisplatin is grade 2B-2A. Deletions: docetaxel + cisplatin (grade 2B). Upgraded carboplatin, oxaliplatin, and capecitabine. Progress in Combined Radiotherapy A phase II clinical trial of simultaneous radiotherapy including two courses of S-1 and cisplatin for locally advanced esophageal cancer by H. Iwase et al. in Japan showed that two cycles of radiotherapy including S-1 and cisplatin were highly effective and mildly toxic. It suggests that this regimen is expected to be a first-line treatment option for locally advanced esophageal cancer. Progress in the treatment of advanced, metastatic recurrent esophageal cancer In view of the in-depth research in this area, the 2011 NCCN guideline has changed considerably, with the treatment subdivided into three aspects: first-line, second-line and other treatments. First-line treatment: single-agent or two-agent combinations are preferred; three-agent combinations are only used for patients in good physical status who can be frequently evaluated for toxicity; trastuzumab in combination with chemotherapy is used for patients with Her2/neu overexpressing esophageal cancer (chemotherapy regimen 5-Fu plus cisplatin is level 1 evidence, the rest of the regimen is level 2B evidence, and combining it with anthracycline is not recommended) (Fig. 1); increasing the use of docetaxel and elevating the use of oxaliplatin, capecitabine. Second-line therapy: decision based on patient physical status score (PS) and prior therapy; focus on irinotecan-based therapy; irinotecan + cisplatin level of evidence 2A. Other treatments: increase the choice of two targeted therapies, erlotinib and cetuximab; combination chemotherapy with 5-Fu analogs plus first- and second-line unused drugs gemcitabine, etoposide, mitomycin, etc., or high-potency, low-toxicity liposomal adriamycin; combination with other therapies when appropriate, with a focus on improving quality of life.