Malignancies, associated directly or indirectly with airways, can cause a fatal condition, called malignant central airway obstruction (MCAO). Both endoluminal and extraluminal MCAO are conventionally treated using bronchoscopy-mediated therapies, but in patients unsuitable for bronchoscopic interventions, there are very limited options, especially if the patient needs ventilator support due to the obstruction. Few patients of carcinoma lung with MCAO needing ventilator support have been treated using radiotherapy (RT), with appreciable results. Though multiple risks are associated with shifting such patients out of the intensive care unit, these steps had to be carried out when RT was deemed the only possible solution. In this rare case of carcinoma esophagus with MCAO needing ventilator support and treated with RT, we have shown how RT can be used to increase the possibility of extubation of the patient. Hence, respiratory relief and extubation were aimed and achieved with RT in this case.