Abstract: Objective: To study the role of high-dose-rate brachytherapy (HDR-BT) in the radiotherapy of esophageal cancer. Methods:We reviewed 89patients with esophageal carcinoma treated with radiation therapy between March 1999 and December 2005in our hospital. There were 62patients in the external beam radiotherapy group (EBRT group) and 27 patients in the combination of HDR-BT and EBRT group (combined group). Forty-two patients received sequential or con-current chemotherapy. Patients in EBRT group were firstly treated with parallel-opposed antero-posterior field at a total dose of 40Gy, and then off-cord oblique fields were used at a final median total dose of 65Gy (ranged from 40to 70Gy). HDR-BT was commonly performed weekly for 2-3 times at a dose fraction of 4-7Gy. Some patients received sequential or concurrent chemotherapy with cisplatin and fluorouracil. The endpoints were complete release (CR), improvement of ob-struction, local-recurrence free survival (LRFS) and overall survival (OS). Chi-square test was used for comparison of the difference in CR rate and the improvement in patients’food intaking. Kaplan-Meier method was exployed to analyze pa-tient survival and Log-rank test was used to compare the difference in OS and LRFS. Results: The median follow-up period was 34months. Sixty-three patients died during the follow up. The CR rates of EBRT group and combined group were10% and 29%, respectively (P=0.049 ). The improvement rate in food intaking in the two groups were 67.7% and 74.1%, respec-tively ( P=0.795 ). The 5-year LRFS was 24% in EBRT group and36% in combined group (P=0.332 ). The 5-year OS was 18% in EBRT group and 21% in combined group (P=0.401 ). The 5-year OS was 42% in patients with tumor smaller than 5cm and 36% in patients with tumor larger than5cm (P=0.045 ). The 5-year OS was 16% in patients treated with brachy-therapy and 14% in patients who didn’t receive brachytherapy ( P=0.685 ). Conclusion:The combination of HDR-BT and EBRT can improve the response rate and the long term survival of patients with small esohpageal carcinoma.