Background Esophageal cancer is the sixth most common cause of cancer-related death worldwide.Prior studies had demonstrated potential synergistic antitumor activity of gemcitabine in combination with cisplatin.Therefore,we studied the efficacy and tolerability of such combination for esophageal cancer.Methods Between October 2003 and October 2006,thirty-eight patients with metastatic or recurrent advanced squamous cell carcinoma of the esophagus were enrolled.The median number of treatment cycles per patient was 4 (range 1-7).Gemcitabine was given at 1000 mg/m2 over 30 minutes on days 1,8 and cisplatin 40 mg/m2 was given on days 1,2 in an every 21-day cycle.Results The median follow-up for all 38 patients was 76 months (range 11-88 months).The overall response rate was 42.1％ (95％CI,25.5％-56.5％).Median progression-free survival and median survival for all patients were 4.1 months (95％CI,3.0-5.7 months) and 10 months (95％CI,7-12 months),respectively.Patients with a response had significantly longer median survival compared with the patients without a response (11 months vs.7.5 months,P=0.0069).Overall survival at 1 year was 36.8％,at 2 years was 10.5％,and at 5 years was 5.3％.The most common grade 3-4 toxicity for all patients was leucopenia (44.7％).Conclusions This cisplatin-gemcitabine regimen was manageable and had significant efficacy in patients with esophageal squamous cell carcinoma.Patients with a response had improved survival time.Furthermore,a small number of the patients with metastatic esophageal cancer were still alive in 5 years with this regimen.