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OBJECTIVE To evaluate the response rate and tolerance of patients with middle-late esophageal carcinoma, who were treated with concurrent chemoradiotherapy (CCRT) plus thalidomide. METHODS Sixty-five eligible patients with local middle-late esophageal carcinoma were randomly assigned to the treatment group (TG) and the control group (CG). The 33 patients from the TG were treated with CCRT plus thalidomide (a 60-70 Gy of radiation dose, and 5-FU plus cisplatin; oral administration of thalidomide at a dose of 100 mg/d on the first week and 200 mg/d on the second. Both were taken with water, at bedtime until completion of the radiotherapy. In the CG, 32 patients received CCRT only. The clinical effects and tolerance to the CCRT between the 2 groups were compared. RESULTS The response rates of the therapeutic combination in the TG and CG were 87.9% and 68.7%, respectively. There were no statistical differences in comparing the response rates between the 2 groups (P > 0.05); the local control rates in the TG and CG were 93% and 91%, respectively, and there were no statistical differences between the 2 groups (P > 0.05); the 1-year survival rates of the patients in the TG and CG were 74.0% and 63.0%, respectively, without statistical differences between the 2 groups (P > 0.05). The improvement rates of KPS scoring in the TG and CG were 57.6% and 31.3%, respectively. There were significant differences in comparing the improvement rates between the 2 groups (P < 0.05). The incidence rates of nausea and vomiting were lower in the TG compared to the CG, with a statistical significance between the 2 groups (P < 0.05). However, the incidence rates of constipation, lethargy and fatigue were higher in the TG than in CG, showing a statistically significant difference between the 2 groups (P < 0.05). CONCLUSION CCRT combined with thalidomide in treating esophageal carcinoma may improve the quality of life of the patients, the treatment may also raise patients' Compliance to chemoradiotherapy, and possibly increase their long-term survival rate. Further studies related to this topic are needed.