Abstract: Objective To investigate the efficacy and side effects of intensity modulated radiation therapy(IMRT) and conventional radiotherapy(CRT) in the treatment of esophageal carcinoma in older patients aged over 80 years. Methods The clinical data of 41 cases of senile esophageal carcinoma (aged over 80 years) undergoing radiotherapy in our hospital between November,2009 and October,2012 were reviewed retrospectively.18 cases received IMRT and 23 cases received CRT with a total radiation dose of 48-69 Gy and 24-34 fractions.The short-term,long-term efficacy,symptom relief rate,toxic and side effects were statistically analyzed,and Kaplan-Meier method was used to analyze the survival rate,Log-rank test was used to evaluate the difference between the groups. Results The short-term response rates in the IMRT group and the CRT group were 88.9% and 60.9% respectively,the difference was statistical significant(χ²=4.308,P=0.044);The Median Survival Times were 12 months and 9 months for each;The 1- and 3- survival rates were 44.4%(8/18),21.7%(5/23)and 16.7%(3/18),4.3%(1/23)and had statistical significance(χ²=5.919,P=0.015).The symptom relief rates of the IMRT group and the CRT group were 83.3%(15/18) and 82.6%(19/23),respectively,and there was no statistical significance(χ²=0.004,P=0.951).The adverse effect mainly included radioactive esophagitis,pneumonia,myelo suppression and anorexia (grade 1-2).There was no radio therapeutic toxic and side effects over Level 3 in both groups. Conclusion Radiotherapy is a safe and efficient way for the aged esophageal carcinoma patients over eighties.IMRT can improve the therapeutic efficacy.