A report is given of the follow-up and behavior of 149 supraglottic squamous carcinomas treated by combined radiosurgical therapy. In 27 cases supraglottic laryngectomy and in 4 cases epiglottectomy was performed. The other cases underwent laryngectomy. The 3-year survival rate was 60% and the 5-year survival rate 51.2%. 64% of the patients without nodular metastases and 45% of the patients with histologically ascertained nodular metastases survived the 3-year interval. The main localizations of the supraglottic tumors are compared with the tendency to spread into unilateral, homolateral, contralateral or bilateral sites, respectively. A comparative study by serial sectioning of 51 supraglottic squamous carcinomas shows that the tendency to nodular metastases increases with decreasing differentiation of the tumor.