Purpose The authors compared definitive intensity-modulated radiotherapy (IMRT) with definitive conventional radiotherapy (2D-RT) in cervical oesophageal squamous cell carcinoma (CESCC).Materials and methods A total of 101 patients with CESCC treated with definitive radiotherapy from January 2001 to April 2012 were analysed.37 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 overall survival (OS) between the groups.Compared with 2D-RT, the rate of grade 3 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 declined using IMRT, thereby resulting in an improved therapeutic ratio for patients with CESCC.