Objective To study and analyze the efficacy and safety of ritotrexate combined with platinum in chemotherapy of advanced esophageal cancer. Methods: 80 patients with advanced esophageal cancer admitted from January 2020 to December 2021 were selected and allocated by lot. 5-fluorouracil+cisplatin was used in the routine group, and the combination of ritotrexate and platinum (oxaliplatin) was used in the observation group. The medicinal effect was analyzed. Results: The treatment was effective. In the two groups, the observation group had a higher effective rate after the treatment (P<0.05). The incidence of adverse reactions during the treatment was lower in the observation group than in the conventional group (P<0.05). Compared with the immune system function indicators, the observation group had a better immune system function after the treatment (P<0.05). Compared with the two groups, the tumor markers in the observation group significantly decreased (P<0.05), The observation group had obvious advantages between the two groups (P<0.05). Conclusion: Chemotherapy is effective and safe in the treatment of advanced esophageal cancer.