Patients with advanced squamous cell carcinoma of the head and neck often require total laryngectomy, but many patients will refuse the procedure despite the prospect of a lower cure rate. Radiation therapy alone can cure selected patients. Chemotherapy has been combined with radiation in a variety of ways, in hopes of improving local control, preserving function, and achieving survival better than that achieved with radiation therapy alone. Several studies have yielded encouraging results, including the only randomized study that has compared chemotherapy/radiation to standard total laryngectomy and postoperative radiation therapy. All function preservation treatment programs require a motivated and compliant patient, careful patient monitoring, and close cooperation among surgical, radiation, and medical oncologists.