Compared to lung cancer, treatment algorithms for esophageal cancer are not well established as a consequence of the low incidence of esophageal malignancies. Radiation therapy and chemotherapy as single modality therapies are inadequate for a reliable cure. Current debate in the literature focuses on the potential added value of neoadjuvant chemoradiation therapy prior to surgery versus surgery alone. We believe this debate is secondary to the lack of careful discrimination with respect to staging of high-risk groups. We advocate the selective use of neoadjuvant chemoradiation therapy for localized esophageal cancer, similar to its use in stage IIIA (N2) NSCLC, and justify this approach on the basis of our own single institution data, which is summarized in this article.