Objective To compare surgery (S) alone with combined radiotherapy and surgery (R+S) in the management of patients with supraglottic laryngeal cancer.Methods Between 1981 and 1994, patients were stratified according to stage and randomised to either surgery (S) or 4000cGy of radiotherapy and surgery. There were 102 patients in the S group and 99 in the R+S group who completed at least 3-year follow up.Results Using Kaplan-Meier survival method showed no significant difference between the two groups. When the patients were grouped according to tumour stage, a significant reduction in the regional recurrence was noted in the R+S group for stage Ⅰ-Ⅲ disease (Cox multivariate analysis, P<0.02). They had an increased relative risk of 1.8 (95% confidence 1.1-2.9) for neck recurrence. There was no significant difference in neck recurrence rates in the two groups for stage Ⅳ disease. When Cox proportional hazard model was used, only TNM stage (P<0.02) and histological nodal status (positive lymph nodes, P<0.01) were found to be independent risk factors for regional control.Conclusion Preoperative radiotherapy can improve regional cervical control of stage Ⅰ-Ⅲ supraglottic cancer as compared with surgery alone.