A twice-a-day treatment schedule has been used to manage 57 patients with moderately advanced and advanced squamous cell carcinomas of the head and neck between March 1978 and July 1981. Fifty patients received radiation therapy alone to the primary site with neck dissection added in 13; seven received preoperative irradiation followed by resection of the primary lesion and clinically positive lymph nodes. A dose of 120 rad was delivered twice daily to the primary site and upper neck nodes with a 4- to 6-hour interval. The dose from external beam was usually 7440 to 7680 rad for irradiation alone to the primary site. An interstitial implant boost of 1000 to 1500 rad was added in four patients. When at least 7440 was used, 2 of 3 and 11 of 13 T3 lesions were locally controlled with a 2- to 5-year follow-up. T4 lesions were initially treated with 7440 rad, but only one of ten lesions was controlled; the dose was then increased to 7680 to 8100 rad, with or without an implant, and three of eight T4 lesions were controlled. The acute effects were tolerable, and similar to those seen with once-a-day treatments. There has been one possible severe complication of irradiation and two severe complications of salvage operations. The late normal tissue effects of radiation are probably reduced, but the number of patients observed for 4 and 5 years is limited. Determinate survival free of disease at 2 years for the entire group is 47%. The 2-year determinate disease-free survival for Stage III was 86% (6/7), for Stage IVA, 63% (12/19), and for Stage IVB, 22% (5/23).