Objective To evaluate the efficacy and safety of concurrent chemoradiotherapy combined with capecitabine in patients with locally advanced esophageal cancer. Methods A total of 120 patients with locally advanced esophageal cancer treated with concurrent chemoradiotherapy at The First Affiliated Hospital of Henan University of Science and Technology from January 2023 to January 2024 were retrospectively analyzed. According to the concurrent chemotherapy regimen, patients were divided into control group (cisplatin-based concurrent chemoradiotherapy) and observation group (cisplatin-based concurrent chemoradiotherapy combined with capecitabine), with 60 patients in each group. Short-term treatment response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events were compared between the two groups. Results The objective response rate in the observation group was significantly higher than that in the control group (P＜0.05). The follow-up results showed that the PFS and OS times of the observation group were significantly longer than those of the control group (both P＜0.05). The Kaplan-Meier survival analysis demonstrated that there was a statistically significant difference between the two groups (P＜0.05). Although the incidence of grade I-II adverse events was slightly higher in the observation group, no significant difference was observed in the incidence of grade ≥III toxicities between the two groups (P＞0.05). All adverse events were manageable, and no treatment-related deaths occurred. Conclusion The addition of capecitabine to cisplatin-based concurrent chemoradiotherapy improves short-term tumor response and survival outcomes in patients with locally advanced esophageal cancer without significantly increasing severe toxicities, suggesting that this regimen is effective and well tolerated in clinical practice.