A prospectively recorded 5-year series of 254 patients receiving elective neck irradiation is evaluated. All had clinically negative necks and initial control at the primary site. Forty-seven percent of the patients had T3–4 tumours. Radiotherapy was delivered from a megavolt source at 2 Gy/day 5 days a week to a total dose of 46–50 Gy. All but 3 patients completed the treatment as planned. Neither tumour stage nor site of the primary tumour was related to the incidence of regional recurrences. Of 30 patients receiving 46–49 Gy, 5 died from neck node recurrences. Of 221 patients treated to 50 Gy or more, 16 (7.2 %) developed regional recurrences. Two of these recurrences were avoided, giving a regional failure rate of 6.3 %. As a whole, 7.8 % died from regional, 11.4 % from local, and 3.1 % from distant recurr