In the past two decades, chemotherapy has been used increasingly as a part of multimodality treatment for patients with advanced carcinomas of the head and neck. In spite of the number of trials over this period, its role remains unclear. In patients with unresectable tumors, induction chemotherapy has failed to improve the bad results of conventional radiotherapy. Concurrent radio-chemotherapy, either given as a simultaneous or alternating combined regimen, is superior to sequential chemotherapy in patients with unresectable tumors. Especially platinum-containing chemotherapy with simultaneous accelerated and/or hyperfraction-ated radiotherapy are very promising methods for future trials. In patients with resectable tumors, and especially stage II and III disease, induction chemotherapy as well as adjuvant chemotherapy is justified in controlled trials. Goals of such trials should be to improve survival and preserve organ function.