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INTRODUCTION: Cervical esophageal squamous cell carcinoma (SCC) is primarily treated by either concurrent chemoradiotherapy (CRT) or pharyngo-laryngo-esophagectomy (PLO). Literature evidence directly comparing CRT to PLO for curative intent is lacking. Although laryngeal preservation in CRT is more preferred, whether CRT can produce comparable disease control and survival over PLO is yet to be elucidated. METHOD: This study aims to compare the recurrence rate and overall survival after CRT and PLO for cervical esophageal cancer. A retrospective comparison was conducted on consecutive patients receiving either definitive CRT or PLO in Prince of Wales Hospital. RESULTS: Between January 1998 and June 2010 (12.5 years inclusive), 57 patients (47 males and 10 females) with mean age of 61.4 ± 8.0 years received curative treatment for cervical esophageal cancer. Forty patients (70.1%) received definitive CRT while 17 patients (30.9%) underwent PLO with either gastric (94.1%) or colonic transposition (5.9%). Clinical AJCC stage I, II and III diseases were confirmed in 0 (0%), 9 (22.5%) and 31 (77.5%) patients in CRT group while those in PLO group were 0 (0%), 4 (23.5%) and 13 (76.5%) patients respectively. Both groups were comparable for age, gender, ASA class and clinical stage. In CRT group, all patients completed two courses of chemotherapy (infusional 5-fluorouracil plus cisplatin) and radiotherapy (dosage 50-60Gy). Complete tumor response was observed in 21 patients (52.5%). Of the remaining 19 treatment failure patients, 5 (12.5%) underwent salvage PLO, 1 (2.5%) refused salvage surgery, and 13 (32.5%) had distant metastasis upon re-staging. In PLO group, the operative morbidity and mortality rates were 70.5% and 11.7% respectively. Three patients (17.6%) had positive margin involvement requiring postoperative adjuvant radiotherapy. In a median follow-up of 14.4 (range 1.2 - 109.9) months, there was no difference in local recurrence rate (42.5% vs. 52.9%, P=0.469) and distant recurrence rate (32.5% vs. 29.4%, P=0.819) between CRT and PLO groups. The overall survival in CRT group was 17.1 (95% C.I. 11.2 - 22.1) months while that of PLO group was 14.4 (95% C.I. 7.8 - 22.9) months. Their difference was not statistically significant (P=0.943, log rank test).CONCLUSION: Despite a relatively high local treatment failure risk, the tumor recurrence rate and overall survival of CRT were comparable to PLO for patients with cervical esophageal cancer.