A 74-year-oldman underwent transthoracic esophagectomy andgastric tube reconstruction for esophageal cancer 15 years ago. Eleven years after the esophagectomy, he was diagnosedwith gastric tube cancer. He receivedproton beam irradiation therapy. Macroscopic clinical effect revealed complete response at that time. Four years later, due to his discomfort symptom, he was diagnosedwith recurrent gastric tube cancer. Total resection of the gastric tube was performedat our hospital. In pathology findings, poorly differentiated adenocarcinoma was found at the proton beam irradiated part with multiple lymph node metastases in the omentum. He died 8 months postoperatively because of carcinomatous pleurisy. Periodic screening of the gastric tube and early detection of gastric tube cancer at early stage are important.