Data concerning the diagnosis, treatment and clinical course of patients with hypopharyngeal carcinoma (HPC) in all five university hospitals in Finland between 1 January 1990-31 December 1999 were retrospectively analysed. During the study period, 149 HPC cases were diagnosed in 111 men and 38 women (74%/26%), with a mean age of 64.5 years. At the time of diagnosis, 6 patients (4%) had stage I, 11 (7%) stage II, 32 (22%) stage III and 100 (67%) stage IV disease. In 74 (49%) cases, the primary treatment was surgery. Pre- or postoperative radiation therapy was given to 67 patients. Radiation therapy was the primary treatment in 47 (32%) patients, and 12 patients (8%) received concomitant chemoradiation. The overall 5- and 10-year disease specific survival (DSS) was 22 and 13%, respectively. The 5-year DSS was 66% for stage I, 59% for stage II, 31% for stage III and 12% for stage IV disease. In the three major treatment groups, i.e., surgery and radiation therapy, radiation therapy alone and concomitant chemoradiation, the 5-year DSS were 32% for surgery and radiation therapy, 7% for radiation therapy alone and 38% for concomitant chemoradiation. Prognosis of HPC remains poor, especially in the more advanced stages of the disease. In addition to traditional surgery and radiation therapy, concomitant chemoradiotherapy seems to give equal results in tumor control, thus making organ preservation possible in the primary treatment of HPC.