Objective To evaluate the clinical effects and adverse reactions of concurrent radiotherapy combined with S-1 for elderly patients with locally advanced esophageal cancer.Methods From January 2011 to April 2013,a total number of 50 elderly patients with locally advanced esophageal carcinoma were randomly divided into concurrent chemo-radiotherapy combined with S-1 group (treatment group) (25 cases) and radiotherapy alone group (control group) (25 cases).Intensity modulated radiation therapy (IMRT) was administered in all cases,with a total dose of (58-60) Gy/(29-30) fx,conventional fractionation.Patients in the treatment group received S-1 of 80 mg/m2 orally bid on day 1-14,with 21 days as a cycle.All the patients should take it until the end of the radiotherapy treatment.Results The efficacy of the 47 cases could be evaluated.In treatment group,5 cases achieved CR,14 cases PR,3 cases SD,1 case PD.The response rate (RR) was 82.6 ％ (19/23).In control group,3 cases achieved CR,12 cases PR,6 cases SD,3 cases PD.The RR was 62.5 ％ (15/24).There was a statistical significant difference between the two groups.The one-year local control rates of treatment group and control group were 63.6 ％ and 43.5 ％,respectively,and the one-year overall survival rates were 68.2 ％ and 39.1％,respectively.The main toxicities included bone-marrow suppression,gastrointestinal reactions,radiation esophagitis and radiation pneumonitis.The incidences of bone-marrow suppression and gastrointestinal reactions were higher in treatment group than those in control group,but the toxic reaction was mild and tolerable.There were no significant differences in terms of bone-marrow suppression,gastrointestinal reactions,radiation esophagitis and radiation pneumonitis between both groups.Conclusion Concurrent chemotherapy combined with S-1 is more effective in the treatment of the elderly patients with locally advanced esophageal cancer and the toxicity is tolerable,which is worth studying furtherly.