Despite constant improvement in surgical techniques and peri-operative management over the past decades, still about 90% of the Western patients with oesophageal cancer (EC) will die from their disease. Additionally, surgery causes significant mortality and morbidity of the patients. These problems raised the interest in nonoperative, organ-preserving treatment procedures. Apart from metastatic disease, it is not clear from the literature, however, if a nonoperative therapy offers the patients a comparable chance of cure with less toxicity. Therefore, surgery is recommended in localized oesophageal cancer, so far. However, as the number of promising data on combined chemoradiotherapy, particularly in locally advanced tumours, increases, efforts get imperative to investigate the role of nonoperative therapies within randomized clinical trials.