Advanced cancer of the upper air and food passages presents a particular challenge to the radiation therapist. When tumors in these areas become advanced, the patient dies from disease that has extended locally, usually without distant metastases. These tumors are too extensive for surgical cure; however, the whole region can be encompassed by radiation therapy. Unlike the small oral and oropharyngeal lesions, which are eminently curable by aggressive radiation therapy, massive lesions are rarely cured. One reason for this difference in response is the local problem. The large tumor mass is more poorly vascularized, there is a greater number of hypoxic, and therefore, radioresistant tumor cells, and the very large number of tumor cells decreases the statistical chance of damaging all or most of these cells by irradiation. Another reason, however, is the often appallingly poor general condition of such patients. Many of them are malnourished derelicts or chronic alcoholics.