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Introduction Benign oesophageal strictures are a recognised complication of radical radiotherapy, with or without chemotherapy (RT±C), for oesophageal cancer, and may cause significant dysphagia requiring repeated endoscopic intervention. We evaluated the incidence, management, and outcomes of post-radiotherapy benign oesophageal strictures at a single UK cancer centre.Methods We retrospectively reviewed all patients treated with curative-intent RT±C for oesophageal cancer between January 2019 and December 2020, with follow-up extending to December 2022 (maximum follow-up duration of 48 months). Patients with symptomatic dysphagia or endoscopic evidence of oesophageal stricture were included. Data collected included time to stricture diagnosis, need for endoscopic therapy, number and timing of endoscopic dilatations, use of intralesional triamcinolone, stent placement, delayed intervention, stricture recurrence, refractoriness, and complications. Recurrent strictures were defined as the requirement for repeat endoscopic dilatation after a symptom-free interval of ≥3 months. Refractory strictures were defined as failure to achieve or maintain adequate luminal patency despite more than five endoscopic dilatations. Delayed intervention was defined as first endoscopic dilatation performed more than 4 weeks after stricture diagnosis.Results Of 176 patients treated with RT±C, 61 (35%) developed an oesophageal stricture, of which 33 (54%) were malignant and 28 (46%; 16% of the total cohort) were benign. Five of the 33 malignant strictures (15%) were initially diagnosed as benign, with malignancy subsequently identified on further biopsy after one or two endoscopic dilatations, suggesting initial misclassification. Of the 28 patients with benign strictures, 21 (75%) required endoscopic therapy. Two were managed with primary stent placement, while 19 (67%) underwent one or more endoscopic dilatations (total 110 dilatations; median 5 per patient; range 1–16). Six patients (21%) received intralesional triamcinolone. The interval between dilatations ranged from less than 2 weeks to over 3 months, reflecting heterogeneity in stricture behaviour, including periods of symptomatic resolution followed by later recurrence. Nine patients (32%) developed recurrent strictures, four (14%) developed refractory strictures, and six (21%) experienced delayed intervention. Complications occurred in 4 of 21 patients (19%) undergoing endoscopic therapy, including three oesophageal perforations and one aorto-oesophageal fistula. Malignant strictures were managed according to oncology and palliative care pathways.Conclusions Benign oesophageal strictures occurred in more than 1 in 10 patients following radical radiotherapy for oesophageal cancer. These strictures require careful evaluation to exclude recurrent malignancy, often necessitate multiple endoscopic interventions, and are associated with a high complication rate. These findings support the need for structured surveillance and cautious, individualised endoscopic management of post-radiotherapy benign oesophageal strictures.