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(Background)The characteristics and prognosis of carcinoma of the cervical esophagus differ from those of carcinoma of the hypopharynx and thoracic esophagus. A surgical resection (OP) is widely accepted as the standard treatment for advanced carcinoma of the cervical esophagus. On the other hand, oncologists have recently advocated that a nonsurgical approach with definitive chemoradiotherapy (CRT) should be the standard treatment for this disease. It is uncertain whether definitive CRT achieves treatment outcomes comparable to surgery, because conducting a clinical randomized trial is quite difficult because of the differing treatment characteristics.(Objectives)The purpose of this retrospective study was to evaluate the outcomes of patients who received curative treatment, of advanced stage squamous cell carcinoma of the cervical esophagus. (Material and Methods)A total of 50 patients with squamous cell carcinoma of the cervical esophagus were treated from September 2002 to December 2009. Among them, 30 patients were resectable cases. This population included of 6 patients with clinical Stage -II disease, 40 with Stage III, and 4 with Stage IV (the 6th UICC-TNM Classification) squamous cell carcinoma of the thoracic esophagus. The CRT regimen was 5-fluorouracil combined with cisplatin plus 30 Gy of radiation. This treatment was repeated twice every 5 weeks, followed by chemotherapy, which was repeated every 4 weeks. The average observation period was 777 days. The treatment outcomes were reviewed retrospectively. (Results) The initial treatment was OP in 9 patients and CRT in 41 patients (including 21 resectable cases). The complete response (CR) and partial response rate after definitive CRT was 44% (57% in resectable cases), 56%, respectively. Eleven (27%) patients received TPN and seven (17%) underwent gastrostomy during CRT period. Seven patients (17%) underwent salvage surgery. Sixteen patients underwent OP including salvage surgery. The mortality and morbidity rate were zero and 38%, respectively. The overall 1-, 2-, and 3- year survival rates in CRT group were 76%, 51% and 42%, respectively, and 65%, 49%, 49%, respectively in the OP group. Postoperative oral intake was good in all patients. (Conclusions) These results suggest that the patients responded as well to CRT as to OP. Definitive CRT provides at least comparable survival as surgery. The frequency of salvage treatment after definitive CRT was higher in the CRT group. Oral intake was good in the OP group. These results should be presented to the patients before determining the initial treatment. OP is recommended for patients with severe stenosis and CRT for preserving the pharynxs. The effectiveness of CRT cannot be predicted, therefore the optimal strategy is the preferred treatment chosen by the patients after they have been fully informed of their options.