In spite of progress in surgery and radiation therapy, esophageal squamous cell carcinoma's outlook remains grim with a cure rate of approximately 10%. The high failure rate is not only due to loco-regional failure but also to distant metastasis. The association of preoperative chemotherapy with radiation has gained interest with hope to improve control of this disease. The present pilot study is an alternating treatment of chemotherapy and radiotherapy for poor risk carcinomas of the esophagus, not primarily amenable to surgery. The chemotherapy is composed of Cis-Platinum 60 mg/m2 Day 1 (D), Mitomycin 8 mg/m2 D1 and Vindesin 3 mg/m2 D1 and D8, alternating with radiotherapy twice 20 Gy in fraction of 2 Gy per day. After reevaluation patients are if possible submitted to surgery and if not, to a third course of treatment to a total of 3 courses and 60 Gy. Seventeen patients were entered in our study with 15 evaluable. The radiochemotherapeutic association was overall well tolerated with no toxic deaths due to treatment. Seven patients had symptomatic improvement after the first treatment cycle. The presurgical evaluation showed 8 CR and 3 PR. Eight patients have been operated with 3 pathological CR and 3 PR. Five patients completed the 3 courses of chemo- and radiotherapy (without surgery) with no improvement compared to the workup before the third course. The survival is as follows: among the 8 operated: 4 are alive without evidence of disease and 4 are dead with 2 postoperative deaths and 1 local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)