The poor progress of advanced esophageal carcinoma cannot be expected to be informed by surgical treatment alone. We retrospectively examined the results of surgery alone (SA: 41 cases) and of concurrent preoperative chemoradiation therapy (PCRT: 67 cases) for stage III or IV esophageal squamous carcinoma. In the PCRT group, the rate of pathological complete response was 32.8% for the primary lesion and 32.8% for metastatic lymph nodes, which viable cancer cells were not recognized in either region in 22.4% of all cases. In the PCRT group, grade 2 or more toxicity was found in 51 cases of leukopenia, 13 cases of anemia, 8 cases of thrombocytopenia, 15 cases of esophagitis, 6 cases of stomatitis, 5 cases of nausea, 3 cases of liver dysfunction and 2 cases of infection. In 3 cases, PCRT was terminated for about 3 weeks because of thrombocytopenia. In the remaining 64 cases, PCRT was administered as scheduled. No statistically significant differences were noted between the PCRT group and the SA group in postoperative complications. There was postoperative recurrence in 18 cases (26.9%) in the PCRT group and 27 cases (65.9%) in the SA group (p=0.008). In stage III the 5-year survival rate was 57.5% for the PCRT group and 14.5% for the SA group (p=0.026). In stage IV, the survival rate was 0% for the SA group and 34.6% for the PCRT group, showing better results in the latter, although there was no statistically significant difference. Multivariate analysis of prognostic variables revealed that therapeutic method (presence or absence of PCRT) contributed the greatest to prognosis. These results indicate that PCRT is an effective adjuvant therapy for advanced esophageal squamous cell carcinoma.