Objective To compare the survival outcomes of different salvage treatments for local recurrence esophageal squamous cell carcinoma after definitive radiotherapy. Methods From June 2012 to October 2016, 124 eligible esophageal squamous cell carcinoma patients were enrolled for the study. The patients were divided into salvage radiotherapy group (SR group comprised of 61 patients) that received salvage radiotherapy and salvage surgery group (SS group comprised of 63 patients) that received salvage surgery. Results The 1-, 3-, and 5-year survival rates of patients in the SS group and the SR group were 57.1%, 23.8%, 9.5% and 52.5%, 14.8% and 4.9%, respectively. The difference was not significant (P>0.05). The 1-, 3-, and 5-year local control rates were 46.0%, 15.9%, 4.8% and 23.0%, 8.2% and 1.6%, respectively. Patients receiving salvage surgery had better local control rates (P<0.05). Cox regression analysis showed that recurrence interval (RFS≤24 months, RFS>24 months) was an independent prognostic factor. The common complications in both groups were gastrointestinal reaction and hematological toxicity, mostly grade 1-2. The incidence of death-related toxicity in the SR group was lower than that in the SS group. Conclusion The survival benefit of salvage radiotherapy is similar to salvage surgery. Given the high death-related toxicity after salvage surgery, salvage radiotherapy may be a better choice for patients with a high probability of developing serious treatment-related toxicity.