BMC Cancer 2006, 6:30 http://www.biomedcentral.com/1471-2407/6/30 Background Various approaches have been developed to intensify standard radiotherapy in locally advanced head and neck carcinomas, such as altered fractionation schemes (hyper- fractionation, acceleration) [1] or combination with chemotherapy [2]. Improved local control and survival have been confirmed in recent trials of concomitant radi- ochemotherapy [2-4]. However, three meta-analyses of radiochemotherapy in advanced head and neck cancer [5] showed that the impact of chemotherapy on overall sur- vival is rather small (improving e.g. 5-year overall survival from 30% to 35%). Compared to radiotherapy alone, concomitant radiochemotherapy shows the biggest improvement with respect to local control and disease- specific survival. As a result, concomitant radiochemo- therapy with cisplatin and 5-FU is increasingly accepted as standard treatment for patients with unresectable head and neck carcinoma and adequate performance status. To date, no randomised study has compared induction chemotherapy followed by concurrent radiotherapy against chemotherapy with a concomitant radiochemo- therapy schedule. We present such a non-randomised comparison with respect to late toxicity, local control and survival in patients with stage IV unresectable head and neck cancers, who were treated according to two different schedules at our institution between 1987 and 1995. Methods Between March 1987 and July 1995, 122 patients were treated with two consecutive phase-II protocols in the departments of radiation oncology and hematology/ FFliogwursehe1et of the two treatment regimes Flow sheet of the two treatment regimes. A (top): treatment schema, sequential protocol (SEQ.). B (bottom): treatment schema, concomitant protocol (CON). Page 2 of 9 (page number not for citation purposes)