Abstract： Objective　 To analyze the death reason of esophageal carcinoma treated by external beam radiotherapy alone, and to enrich knowledge of perforation without evidence of residual tumor at the primary site.Methods　Thirty-two esophageal carcinoma patients who had been treated from 1958 to 1985 by radiotherapy alone were autopsied. This paper presents the findings from their complete records ,which includes 26 patients with the first course of treatment and 6 second course. The total doses ranged from 6～200 Gy.Results　On autopsy,28.1% of patients did not have any residual tumor at the primany site,but 71.9% of patients did have persistent tumor locally. The incidences of disease-free patients in relation to the total dose were: 41 to 59 Gy—5/9 and 60 to 80 Gy—3/9 while those having persistent tumor on these two dose levels were 13.0% and 47.8%. The incidence of disease-free patients in relation to the size of each radiation fraction were<180 cGy —2/9,180～210 cGy —3/9 and >210 cGy —4/9 while those with persistent tumor on these three dose levels were 52.2%,39.1% and 8.7%. Pathologically,extensive inflammatory infilfration was observed in the peri-perforation tissues with abscess formation.Fragmentation of fibrils was observed. Of all cases,46.9% had lymph node metastasis, 50% of the upper segment lesions developed subdiaphragmatic lymphatic metastasis in contrast to 12.5% from lesion in the lower segment. Generalized metastases were present in 37.5% of cases. 75.0% of patients died chiefly of perforation, among whom 33.3% did so of disease-free perforation. Esophago-aortic fistula observed frequently was most deadly. No one among these 32 patients had survived over five years but their 1-and 3-year survival rates were 15.6%(5/32) and 3.1%(1/32).Conclusions　The couse of death after receiving radiotherapy for esophageal carcinoma is due to local persistent tumor leading to perforation. Yet ,one must be aware of death due to non-cancerous perforation which may be due to infection and abscess formation.