The standard treatment for non-metastatic T3/T4 larynx and hypopharynx cancer varies. This study compared definitive radiochemotherapy to surgery followed by radio(chemo)therapy. Forty-four patients treated with radiochemotherapy were matched to 88 patients receiving surgery plus radio(chemo)therapy. Groups were matched 1:2 for eight factors including age, gender, performance status, tumour site, histologic grade, T-/N-category and AJCC stage. Groups were compared for loco-regional control, metastases-free survival, overall survival and toxicity. Two-year loco-regional control rates were 75% after surgery plus radio(chemotherapy) and 66% after radiochemotherapy (p = 0.39). Metastases-free survival rates were 76% and 77%, respectively (p = 0.76). Overall survival rates were 67% and 63%, respectively (p = 0.95). During follow up, 60% and 9% of the patients, respectively, received a total laryngectomy (p = 0.004). Grade ≥3 oral mucositis and haematologic toxicity rates were higher with radiochemotherapy. Other toxicities were similar. Outcomes of radiochemotherapy appeared similar to those of surgery plus radio(chemo)therapy. The larynx preservation rate was higher after radiochemotherapy. © 2011 Elsevier Ltd. All rights reserved.