The incidence rate of esophageal cancer accounts for the eighth place of all malignant tumors, and there are about 480,000 new cases in the world every year. China is a high incidence area of esophageal cancer, with an average of 150,000 deaths per year, accounting for the 4th place of all malignant tumor deaths. At present, the first choice of treatment for esophageal cancer is still surgery, and the survival rate of early postoperative 5 years in the Department of Traditional Chinese Medicine of the First People’s Hospital of Hangzhou City, He Fulle, reaches 90%, but the vast majority of the patients are in the middle and late stages, and those who can be operated only account for 20%, and the survival rate of 5 years after operation is 20-30%, and the overall survival rate of esophageal cancer has not been improved significantly in the past 25 years. The overall survival rate of esophageal cancer has not been significantly improved in the past 25 years. It is difficult to substantially improve the efficacy of any single treatment modality. Reasonable arrangement of comprehensive treatment procedures in a purposeful and planned way has been widely emphasized. If the cancer has invaded or has adhesion with neighboring organs, it is not easy to be completely resected or cannot be resected by surgery, and there is also an increased risk of cancer spreading and planting. Appropriate amount of preoperative radiotherapy can make the tumor shrink, reduce the vitality of cancer cells, occlude the small blood vessels and lymphatic vessels around the tumor, fibrosis of surrounding tissues, improve the local resection rate and reduce the metastasis rate, and improve the survival rate. Liu Yanzhong divided 864 patients with stage III esophageal cancer into two groups. In the radiotherapy group, 526 cases were treated with preoperative radiotherapy and surgery, and in the control group, 338 cases were treated with surgery alone. The radical surgical resection rate and 1-year survival rate of the radiotherapy group were significantly higher than those of the control group (P＜0.01), and the differences in postoperative complications and 5-year survival rate between the two groups were not statistically significant (P＞0.05). The results showed that preoperative radiotherapy for stage III esophageal cancer could improve the radical surgical resection rate, without increasing postoperative complications, and improve the recent prognosis. In a study conducted by Quanxi Liu, the observation group was given preoperative radiotherapy of 40 Gy and radical esophagectomy with small incision in the left chest was performed 2-3 weeks later, while the control group underwent radical esophagectomy with conventional incision. The results showed that the observation group could improve the recent survival rate and reduce the postoperative complications. 2. Preoperative concurrent radiotherapy The effect of preoperative concurrent radiotherapy in the adjuvant treatment of esophageal cancer is more remarkable. Firstly, radiotherapy can take care of local tumor and possible micro-metastases at the same time. Secondly, some chemotherapeutic drugs have the effect of sensitization of radiotherapy, and the concurrent use of radiotherapy can reduce the dose of radiotherapy in order to minimize the adverse effects and improve the adherence and efficacy of treatment. For patients with locally advanced disease, preoperative radiotherapy can reduce the size and stage of the tumor and increase the surgical resection rate, which is expected to improve the long-term survival rate.The results of a phase III clinical trial by Stahl et al. showed that there was no difference in the surgical resection rate between the two groups when compared with the preoperative chemotherapy, but the group of preoperative radiotherapy had a higher complete pathological response (pCR) rate. There was no difference in the surgical resection rate between the two groups compared with preoperative chemotherapy, but the preoperative radiotherapy group had a higher rate of complete pathological response (pCR) and negative lymph node clearance (15.6%:2.0% and 64.4%:37.7%, respectively), and the 3-year survival rate in the preoperative radiotherapy group increased from 27.7% to 47.4%. Another phase III trial concluded that preoperative radiotherapy improved the median survival time and 5-year survival rate compared with surgery alone (4.48:1.79 and 39%:16%, respectively). Several recent Meta-analyses have also confirmed that concurrent preoperative radiotherapy + surgery significantly prolongs 1-, 2-, and 3-year survival, reduces the rate of local recurrence, and decreases the risk of death compared with surgery alone, but does not reduce the incidence of postoperative complications. The median overall survival of concurrent chemo-radiotherapy-naïve patients who underwent salvage surgery was 11.2 months higher than that of patients who did not undergo surgery; therefore, salvage surgery is an effective treatment option for concurrent chemo-radiotherapy-naïve patients. Prospective clinical studies at home and abroad have found that pCR is significantly associated with survival rate, and pCR has become an important index for judging the prognosis of esophageal cancer. Diaz et al. designed a clinical study in which 73 patients with esophageal cancer were treated with preoperative cisplatin-decafluorouracil + radiotherapy (50.4 Gy), and the clinical complete remission rate was 54%, among which 25 patients received sequential surgery, with a 32% pCR, and 16 patients who could not be operated had an additional cycle of surgery. In addition, 16 inoperable patients received one additional cycle of chemotherapy and 10 Gy of radiotherapy, with a median survival time of 10.33 months, and 2- and 5-year survival rates of 22% and 16%, respectively, and the factor that significantly affected the survival time was the rate of complete remission. Therefore, further improvement of pCR in the comprehensive treatment of esophageal cancer is the key to the next clinical research. The purpose of postoperative radiotherapy for radical esophageal cancer is to eliminate subclinical lesions to improve the survival rate. Postoperative radiotherapy can be divided into 2 cases: one is that the cancerous tissue cannot be completely removed by surgery, and postoperative radiotherapy can further eliminate the remaining cancerous tissue. The other is prophylactic radiotherapy after radical surgery. The existing evidence is not certain about the advantages and disadvantages of prophylactic radiotherapy after radical surgery for esophageal cancer, but the number of lymph node metastases is one of the factors affecting the survival rate of patients with esophageal cancer.A phase II clinical trial by Schreiber et al. included 1,046 patients with esophageal cancer, of whom 683 were treated with radiotherapy alone, and 363 were treated with postoperative radiotherapy, and the results showed that the treatment of esophageal cancer with postoperative radiotherapy was not effective according to the results of a study conducted by the Americanjoint Committee on Cancer, Inc. The results showed that postoperative radiotherapy improved 3-year survival and disease-specific survival in patients with stage III or higher according to the American Joint Committee on Cancer (AJCC), but did not have a significant advantage in patients with stage II. It is currently believed that postoperative prophylactic irradiation is beneficial for palliative surgery patients, stage III patients and patients with positive lymph node metastases, and can improve survival. 4.Postoperative concurrent radiotherapy Most clinical studies of postoperative adjuvant radiotherapy for esophageal cancer have not achieved satisfactory results, so it is combined with chemotherapy with a view to becoming a better treatment choice for postoperative patients and improving survival.Bedenne et al. have shown that compared with radical radiotherapy, postoperative radiotherapy has a significant improvement in local control rate. The Southwest Oncology Collaborative Group (INT) 0116 study demonstrated that postoperative adjuvant radiochemotherapy can improve the overall survival rate (P=0.004) and tumor-free survival rate (P <0.001), and concluded that the most ideal mode of postoperative adjuvant treatment for N1 esophageal cancer is postoperative radiotherapy + chemotherapy. Most patients with esophageal cancer have poor systemic conditions after surgery and are difficult to tolerate radiotherapy. Therefore, postoperative radiotherapy and chemotherapy should be implemented selectively according to the specific conditions of patients. stage II and III esophageal cancer tolerates postoperative concurrent radiotherapy and chemotherapy well, so postoperative concurrent radiotherapy and chemotherapy is recommended. Simultaneous radiotherapy Simultaneous radiotherapy is often used for patients with late clinical staging, hypopharyngeal and upper thoracic occupancy, limitation of organ function and unwillingness to accept surgery. The aim is to utilize the complementary and synergistic effects of radiotherapy and chemotherapy in the hope of improving the local control rate and reducing distant metastasis, thus improving the survival rate. Its value has been confirmed in several clinical trials, and a meta-analysis by Wong and Malthaner concluded that concurrent radiotherapy improved overall survival, tumor-free survival, and local control rates in patients with esophageal cancer when compared with sequential radiotherapy. Comparing radical radiotherapy with traditional surgical resection, the difference in overall survival rate and tumor-free survival rate of esophageal squamous cancer was not statistically significant, which further affirmed the status of radical radiotherapy in the treatment of esophageal squamous cancer. Some of these clinical studies even concluded that patients undergoing preoperative radiotherapy should be converted to radical chemoradiotherapy if the tumor is in obvious clinical remission with good regression, instead of recommending sequential surgical treatment, because sequential surgery would rather increase the risk of treatment-related death, while sequential surgical salvage treatment can be chosen when the tumor is insensitive to chemoradiotherapy. Simultaneous chemoradiotherapy for esophageal cancer has the advantages of preserving organs, improving patients' quality of life, lowering local recurrence rate and prolonging survival period compared with radiotherapy alone. At present, simultaneous chemoradiotherapy has become the standard local non-surgical treatment for squamous esophageal cancer in the United States and Europe. Simultaneous chemoradiotherapy with new target drugs In recent years, molecular targeted drugs combined with radiotherapy is the hotspot of tumor treatment. Commonly used molecular targeted drugs include anti-epithelial growth factor receptor (EGFR) drugs, tyrosine kinase inhibitors, anti-HER-2 monoclonal antibody, vascular endothelial growth factor (VEGF), and other drugs that can be used to treat esophageal squamous carcinoma. （EGFR, tyrosine kinase inhibitors, anti-HER-2 monoclonal antibodies, vascular endothelial growth factor (VEGF) inhibitors, cyclooxygenase (COX) inhibitors, and so on. (1) ECFR monoclonal antibody The positive expression rate of esophageal cancer is 50%-80%, EGFR targeted inhibitors can improve the radiosensitivity of tumor cells by blocking multiple signaling pathways related to EGFR. Safran et al. chose 57 cases of esophageal cancer, and gave them cetuximab combined with paclitaxel and carboplatin chemotherapy, and matched them with 50.4 Gy of radiotherapy at the same time, with the result that 40 cases achieved complete remission, and there was no increase in adverse effects related to the treatment. The results showed that 40 cases achieved complete remission and there was no increase in treatment-related adverse reactions, suggesting that cetuximab may have a certain sensitizing effect on radiotherapy. (2) Tyrosine kinase inhibitors Ferry et al. reported that gefitinib was used to treat 27 cases of advanced esophageal adenocarcinoma, 70% of which had previously received chemotherapy, with the results of oral gefitinib 250 mg/d, 13% achieved partial remission, 29% reached stability, with a median time to progression of 1.9 months, and the genetic analysis of tumor tissues found that genes related to the cell proliferation and apoptosis pathways were down-regulated after treatment. In a phase II clinical trial by Rodriguez et al, patients received preoperative radiotherapy with cisplatin 20 mg/m2 on days 1-4, fluorouracil 1,000 mg/m2 on day 1, and radiotherapy 30 Gy/20 f twice daily; surgery was performed 4-6 weeks after radiotherapy, and then radiotherapy was performed 6-8 weeks after the operation, with the same regimen as that of the preoperative period; gefitinib was administered orally during the same time period as preoperative and postoperative radiotherapy (250 mg/d) and postoperative radiotherapy. Gefitinib (250 mg/d) was administered orally at the same time as the preoperative and postoperative radiotherapy and maintained for 2 years after surgery. The experimental group showed no increase in adverse effects except for mild rash and diarrhea, and patients with diarrhea had a tendency to have a good prognosis when compared with the group without gefitinib. Another phase II clinical trial reported 22 cases of erlotinib (150 mg/d) monotherapy for esophageal cancer, with 2 cases of partial remission, 10 cases of stabilization, and 10 cases of progression after 4 weeks, suggesting that the efficacy of erlotinib is certain. (3) Anti-HER-2 monoclonal antibody It is reported that the positivity rate of high C-erbB2 expression is around 10%. For patients with HER-2 positive esophageal adenocarcinoma, Safran et al. added trastuzumab to paclitaxel + cisplatin regimen combined with radiotherapy, 25 mg/m2 of cisplatin and 50 mg/m2 of paclitaxel per week, and 50.4 Gy of radiotherapy during the same period, for a total of 6 weeks of treatment. There was no increase in adverse effects and no increase in efficacy. (4) VEGF inhibitor VEGF is highly expressed in many malignant tumor tissues and is closely related to biological behaviors such as invasion, metastasis and poor prognosis.Shah et al. chose 20 patients with advanced esophageal cancer who had lost their surgical indication, and treated them with a combination of bevacizumab, irinotecan, and cisplatin, and the disease control rate reached 87%. In addition to bevacizumab, vascular endothelial inhibitor is also a multi-target angiogenesis inhibitor, which can specifically act on endothelial cells, especially microvascular endothelial cells, inhibit their migration and induce their apoptosis, thus inhibiting angiogenesis and tumor growth. (5) COX inhibitor COX is an important rate-limiting enzyme that catalyzes the oxidative synthesis of prostaglandins from arachidonic acid, of which COX-2 has been shown to be significantly up-regulated in a variety of tumors, especially digestive tumor tissues and the corresponding tumor cell lines, and has been regarded as one of the early events in tumor formation. Among the COX-2 inhibitors, the most representative drug is celecoxib. Phase II clinical studies by clinical research organizations, including the Anderson Cancer Center, have shown that the combination of COX-2 inhibitors with chemoradiotherapy for locally advanced esophageal cancer has initially demonstrated a high degree of safety and superior efficacy in neoadjuvant and maintenance therapy for esophageal cancer. The application of molecular targeted therapy has brought the possibility of prolonging the survival period and improving the quality of survival of esophageal cancer patients. Esophageal cancer is a complex disease with many potential targets that can be blocked or inhibited. With the deepening of research, the new generation of antitumor drugs targeting molecular targets will become the main research direction for esophageal cancer treatment by virtue of their specificity and targeting. 7. Conclusion Esophageal cancer has a poor prognosis, and the rational formulation of individualized multidisciplinary comprehensive treatment plan can improve the survival period and enhance its quality of life. New therapies are needed to improve the survival and quality of life of advanced, recurrent or metastatic esophageal cancer. The continuous emergence of new anticancer drugs and the development, research and clinical application of molecularly targeted drugs make the prospect of comprehensive treatment of esophageal cancer broader. It is expected that the planned and reasonable combination of surgery, radiotherapy, chemotherapy, molecularly targeted therapy and other therapeutic means, which give full play to their respective potential, complement each other's strengths and synergize each other's effects, will bring about a breakthrough in the treatment of esophageal cancer.