Optimization of radiation therapy for head and neck tumors requires the combination of several facets of radiation biology and physics. The aim is to achieve optimum tumor control while reducing normal tissue damage. Techniques have been developed to determine tumor radiosensitivity and growth characteristics. Their use as predictive assays of treatment response is gaining importance. As the range of therapeutic options (particularly altered fractionation regimens) increases, it is hoped that the ability to individually tailor patients' treatment will result in improved rates of tumor control and an improved therapeutic ratio. Optimization of treatment delivery based on three-dimensional treatment planning offers the opportunity for dose escalation studies and limitation of normal tissue morbidity. The combination of chemotherapy and radiotherapy continues to be investigated, although major advances using this strategy are unlikely.