Introduction: To compare definitive intensity-modulated radiotherapy (IMRT) with definitive 2D radiotherapy (2D-RT) in cervical esophageal squamous cell carcinoma (CESCC).Methods: A total of 101 patients with CESCC treated with definitive radiotherapy during January 2001 through April 2012 were analyzed.Thirty-seven patients were irradiated using 2D-RT, whereas 64 cases were treated using IMRT.Results: The median follow-up time was 15.5 months for all the patients.For all patients, the overall 2-year local failure-free survival(LFFS), regional failure-free survival(RFFS), and overall survival(OS) rate was 67.4%, 85.2% and 46.2%, respectively.The 2-year LFFS rate and the 2-year RFFS rate in the IMRT group were higher than the 2D-RT group, although no statistically significant difference was observed in LFFS and RFFS.No statistically significant difference was observed in OS between the groups.Compared with 2D-RT, the rate of severe dysphagia after radiotherapy was lower (6.3% vs.8.1%) and none had hypothyroidism requiring lifelong thyroxine replacement in the IMRT group.Matched cases analysis did not show a statistical difference in terms of LFFS, RFFS and OS between the groups.Conclusions: Although no statistically significant difference was observed in OS, LFFS and RFFS between the IMRT group and the 2D-RT group, the incidence of late toxicity had declined by using IMRT, thereby resulting in an improved therapeutic ratio for patients with CESCC.