For the 40 per cent of patients with head and neck cancer who present with stage I and II disease either radiotherapy or surgery can be curative. The remaining 60 per cent have advanced loco-regional disease and even when treated with surgery and radiotherapy the five-year survival is less than 30 per cent. Most patients with relapse have loco-regional disease and second primary tumours have an incidence of three per cent a year.1 Current attempts to improve prognosis include the addition of chemotherapy, the use of brachytherapy and accelerated radiotherapy regimes such as continuous hyperfractionated accelerated radiotherapy (CHART).