Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death related to cancer. In the United States, there are over 16,000 people diagnosed with the disease annually with an even higher prevalence in other parts of the world. The National Comprehensive Cancer Network (NCCN) guidelines suggest surgery as the standard treatment for stage I esophageal cancer. Despite these guidelines, various factors prevent a patient from being managed surgically such as age of the patient, multiple comorbidities and differences in sociodemographic and socioeconomic status. The median age of patients diagnosed with esophageal cancer is around 67 years with a 5-year overall survival (OS) rate of 18.8%. Age often drives treatment decisions of elderly patients (? 80 years of age) representing a unique and challenging subpopulation to health care providers. Randomized clinical trials have shown that survival of patients with esophageal cancer correlates with the degree of treatment intensity they receive. However less aggressive, nonsurgical therapy such as chemoradiation is commonly provided to elderly patients even with early-stage disease.