This study includes 155 patients with T1-4N0 carcinoma of the postcricoid region seen between 1963 and 1993. Sixty-seven were treated by primary surgery, 50 by primary irradiation therapy, 36 were unsuitable for curative treatment and two patients were lost to follow-up. Reasons for deciding against curative therapy were: advanced age, poor general condition and advanced disease at the primary site. This study included only those patients who had no neck node metastases at presentation. Patients receiving surgery tended to be in better general physical condition and tended to have more advanced disease than those treated by irradiation in this series. The tumour-specific five-year survival rate for those treated by surgery was 43 percent (95 percent confidence interval (CI) 23-60 percent). For those patients treated by irradiation the five-year survival rate was 48 percent (95 percent CI 27-66 percent) and for those receiving no treatment the median survival rate was three months (95 percent CI two-six months). The observed survival for the surgery group was only 18 percent and for the radiotherapy group 25 percent at five years. Multiple logistic regression showed no significant difference in proportions of host and tumour factors between the group receiving radiotherapy and the group receiving surgery. Recurrence at the primary site and the appearance of neck node metastases were not predicted by any host or tumour factor. Twenty-one patients out of 67 receiving primary surgery had recurrence at the primary site compared with 26 patients out of 50 receiving primary irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)