The treatment of localized esophageal cancer (LEC) is controversial. The approaches that are used in daily practice include surgery or radiation alone, preoperative or postoperative radiation, preoperative or postoperative chemotherapy, and definitive or preoperative chemoradiation. The varied modalities used to treat LEC reflect both the lack of randomized trial data and the suboptimal results with current therapy. Nonetheless, the available data suggest that surgery and definitive concurrent chemoradiation represent two standard treatment options. The use of preoperative chemoradiation remains investigational, with phase III trials failing to demonstrate a consistent benefit for this option over chemoradiation or surgery alone. This review will examine the available data on the current treatment approaches in LEC.