We reviewed the results of treatment in 52 patients with hypopharyngeal carcinoma who underwent radical radiation therapy using a two-fractionation scheme--conventional fractionation (CF) and accelerated hyperfractionation (AHF)--in order to evaluate the impact of the fractionation scheme on prognosis. The 5-year survival rate for the 52 patients was 19.5%, and a significantly better rate was obtained with AHF (44.4%) than with CF (12.4%). Of 27 patients who showed a complete response (CR), a higher CR rate (61%) was achieved with AHF than with CF (47%). A similar trend was also observed for T3 and T4 tumors (55% with AHF vs. 36% with CF). Multivariate analysis demonstrated that neck node status was a significant factor related to local control, and that local response and the fractionation scheme employed were significant prognostic factors for survival. The recurrence rate and recurrence within the radiation field in the AHF group was lower than in the CF group (27% vs. 50%), although the time to recurrence in the two groups did not differ greatly. Voice preservation was achieved in 20% of the patients. Considering the better survival and local control rate compared with conventional fractionation, accelerated hyperfractionation seems a preferable treatment for hypopharyngeal carcinoma.