Esophageal cancer (EC) is one of the leading causes of cancer-related mortality worldwide.It is a highly malignant tumor with a high local recurrence and distant metastasis.Notably, about half of the world's EC patients occur in China.Smoking, drinking liquor alcohol and eating hot food are the top three risk factors for EC in China.[1] Radiation therapy (RT) plays a pivotal role in the treatment of locally advanced EC patients, and radiation-induced heart diseases (RIHD) has become a clinically concerned problem, which may involve any structure of heart, including coronary heart disease (CHD), atrial fibrillation (AF), valvular heart disease (VHD), pericardial effusion (PE), heart failure (HF), thromboembolic disease (TED) and atrioventricular block (AVB), sick sinus syndrome (SSS), and etc;some of which may occur after 10-15 years or even more decades.[2,3] Herein, we report some cases with severe multiple RIHD after traditional RT and intensity modulated radiotherapy (IMRT) in different ages.To the best of our knowledge, few investigators have focused on relevant similar cases.