A retrospective review of 169 patients with carcinoma of the pyriform sinus was accomplished for a ten-year-period from 1964 to 1974. Of the 169, 80 (47%) were treated with low dose preoperative radiation and partial laryngopharyngectomy (PLP), 57 (34%) were treated with radiation and total laryngectomy-partial pharyngectomy (TLP), and 32 (19%) were treated with palliative radiation, surgery or chemotherapy. Act,arial five-year-survival was 31% for all cases, 59% for the PLP group, 21% for the TLP group and 4% for the palliation group. Eighty to 90% of the relapses occurred within two years. The primary and/or nodal failure rates were 23, 37 and 78%, respectively for the PLP, TLP and palliation groups while the distant metastasis rates were 15, 37 and 34% for the three groups. Sites of failure differed for the three groups with a relatively high rate of contralateral neck metastases (23%) in the TLP group and an overwhelming number of primary and ipsilateral failures (78%) in the palliation group. Retreatment of failures resulted in few salvages (15%) and a significant number of fatal complications (26%). The cause of death was tumor related in most cases.