Three hundred and twelve patients with pyriform sinus or supraglottic cancer were reviewed with respect to effectiveness of therapy upon nodal control. All patients had a minimum 3-year follow-up. Combined modality therapy (radiotherapy and surgery) conferred a higher neck control rate for both N0/N1 and N2/N3 nodes than moderate dose (50 to 60 Gy) radiotherapy alone. Neck dissection appeared to be a significant component of therapy for all neck stages. Fixed nodes, a subset of N2/N3 disease with a very poor prognosis, required combined modality therapy for the best nodal control rates. Downstaging to pN0 with preoperative radiotherapy provided superior nodal control and survival rates.