Mid-stage esophageal cancer is the most manageable and the most efficacious among all stages of esophageal cancer. Surgery and radiotherapy are the main local treatments. The choice of treatment depends on the length of the lesion, whether there are metastases in supraclavicular and surrounding lymph nodes, as well as the patient’s age and functional status of vital organs. In recent years, radiotherapy technology has developed rapidly, and many techniques of precise radiotherapy have been applied in clinical practice. Conventional irradiation + precise radiotherapy (3D conformal radiotherapy) mode has significantly improved the long-term survival rate of esophageal cancer. From the results of a multicenter study with a large sample, there was no significant difference in the 5-year survival rate between surgery and radiotherapy for patients of the same age. As the elderly are 73 years old, open-heart surgery is more traumatic and the recovery time is longer, surgery may not be the first choice if the lesion is staged late. Radiotherapy can both control the disease and improve the quality of survival, killing two birds with one stone.