Abstract: Objective：To evaluate the efficacy of helical tomotherapy combined with chemotherapy in the treatment of thoracic esophageal squamous carcinoma with lymph node skip metastasis. Methods：A total of 86 cases of thoracic esophageal carcinoma with lymph node skip metastasis were retrospectively enrolled. Helical tomotherapy was used for all patients at 5 fractions per week. The most commonly prescribed dose were a total dose of 50.0-56.0 Gy for primary esophageal tumor, 55.0-61.6 Gy for the cervical lymph node metastasis, 50.0-56.0 Gy for the thoracic lymph node metastasis, 50.0-54.0 Gy for the abdomen lymph node metastasis, and 45.0-50.4 Gy for the expansively prophylactic esophageal whole regional lymph node. Paclitaxel and cisplatin were concurrently administered. The survival rate was calculated using the Kaplan-Meier method, and the prognostic analysis was assessed by the Cox-regression model. Results：The median survival time was 496±233 days for all patients with the node skip metastases. Of the 86 patients, 19 patients were still alive as of the last follow-up, 56 patients died of the primary esophageal cancer and lymph node metastasis, 6 patients died of the treatment-related diseases, and 5 patients died of non-neoplastic diseases. And the most frequent observed toxicity adverse reactions were GradeⅠorⅡ. Leucopenia was detected in 46 patients (52.3%), radiation-induced pneumonitis in 8 cases (7.4%), and esophagitis in 40 cases (7.4%); Grade Ⅳ radiation-induced esophageal toxicity was detected in 5 cases (5.8%). Cox model showed that T stage and the number of metastatic lymph node were the main factors affecting the survival of patients (P<0.05). Conclusions：Helical tomotherapy combined with chemotherapy could prolong the survival time of esophageal carcinoma patients who had lymph node skip metastasis, and the adverse reactions of radiotherapy and chemotherapy can be tolerated.