Abstract: Objective To evaluate the curative effect of radiation therapy, failure causes and the feasibility of elective nodal irradiation on early esophageal carcinoma. Methods We analyzed the prognostic factors and failure cause for 123 patients with squamous cell carcinoma and clinical T1-2N0-1M0 stage esophageal carcinoma. And we analyzed those 21 patients who received elective nodal irradiation. The pattern of the failure after treatment included recurrence, distant metastases and lymph nodal metastases. Results The 1-, 3-, and 5-year overall survival rates were 87.8%, 47.2% and 36.5%, respectively. The 1-, 3-, and 5-year local control rates were 89.7%, 67.7% and 49.0%. Cox multivariate model showed that the length of tumor in X-rays, clinical N stage and the response to curative effect were independent prognostic factors. Elective nodal irradiation were not benefi cial to over survival rates or local control rates, but benefi cial to local nodal and distant failure(χ2=5.778,P=0.016). Conclusion Three-dimensional conformal radiotherapy could be one of the best radiation treatment regimens for early esophageal carcinoma. Elective nodal irradiation may be effective for lowering the risk of regional nodal failure while its benefi t to overall survival is still needed further evaluation.