Twenty-six patients with esophageal carcinoma at stage pT4 underwent esophagectomy with lymph node dissection leaving part of the tumor in adjacent organs. Several plastic catheters were fixed to the tumor bed and led to the outside of the thorax for postoperative brachytherapy. Using these catheters, the patients underwent brachytherapy followed by external beam irradiation. The operative mortality rate was 11.5%. No serious complications resulting directly from the brachytherapy occurred. Recurrent disease was found in 17 patients, among whom only six had local recurrence. The median survival of the patients was 314 days, and the 5-year survival rate was 16.2%. Of the 10 patients at stage pT4N0, three survived more than three years after surgery. Tumor bed implant brachytherapy for residual tumor after esophagectomy is a safe and useful treatment strategy for patients with pT4 tumor, especially those without lymph node metastasis.