Radiation therapy continues to play a major role in the management of patients with esophageal carcinoma. This role continues to evolve based on the success of combined modality treatment regimens. During the past decade, the concurrent application of chemotherapy and radiation has gained acceptance as a standard of practice that offers patients an improved opportunity for long-term survival, whereas the ultimate benefit of trimodality therapy remains an unanswered question. The start of the twenty-first century brings the challenge of decreasing the toxicities associated with therapy and the need to improve therapeutic options. The recent advances in technology have positioned radiation oncology to achieve both of these goals.