Radical surgery with extended lymph node dissection has been the main method used for treating patients with resectable esophageal cancer in Japan. Based on data from two phase III studies that compared surgery with or without pre- or postoperative chemotherapy, preoperative chemotherapy followed by surgery emerged as standard treatment for patients with stage II or III disease. Definitive chemoradiotherapy may be an alternative to surgery for those with unresectable as well as resectable esophageal cancer. Recent clinical trials in Japan showed that the survival after definitive chemoradiotherapy was comparable to survival following surgery in stage I disease, with a 5-year survival rate of 75%. However, the 5-year survival rate was worse for chemoradiotherapy (37%) and preoperative chemotherapy followed by radical surgery (60%) for stage II or III disease. In addition, salvage treatment following chemoradiotherapy appeared to be important for patients who did not achieve a complete response or who experienced recurrence. To improve the prognosis for esophageal cancer, a multimodality approach that includes more intensive induction chemotherapy prior to surgery, or possibly chemoradiotherapy containing molecular targeting agents, is preferred. Additional studies are necessary to further elucidate this multimodality approach. Current treatment strategies for esophageal cancer and research initiatives in Japan are reviewed.