Verma V, et al. - Researchers used the National Cancer Data Base to analyze practice patterns in 4,099 elderly esophageal cancer (EC) patients with cT1N1M0/T2-3N0-1M0 EC (like the CROSS trial) but 76 years of age and above and assessed overall survival (OS) between neoadjuvant chemoradiation (nCRT)+ surgery alone (S), S, and definitive CRT (dCRT). Factors related to nCRT+S (vs S) were determined by using multivariable logistic regression. OS was assessed via Kaplan-Meier analysis. Propensity matching was also performed. nCRT+S, S, and dCRT were used to treat 594 (14%), 494 (12%), and 3,011 (73%) patients, respectively. Median OS in these respective groups were 26.7, 20.3, and 17.8 months (P < 0.05). A tendency towards higher OS was seen with nCRT-S over S after propensity matching. dCRT vs nCRT-S offered poorer OS, but this was found to be comparable to S. dCRT was used to treat most of the older patients not meeting CROSS criteria but a rising utilization of trimodality therapy was also reported. With trimodality therapy, a trend towards higher OS was seen without poorer postoperative outcomes. Nevertheless, careful patient selection remained essential in this population.