Radiation therapy is the treatment of choice for most patients with T1 and T2 carcinomas of the vocal cord, resulting in high rates of local control and preservation of voice. Though surgical options also result in high rates of local control, vocal quality is inferior. Endoscopic laser surgery has been used only on small numbers of selected T1 lesions. Its role needs to be defined as vocal quality tends to be inferior to radiation therapy and substantial numbers of patients require additional treatment.