In addition to clinical examination and less sophisticated radiographic techniques, high-resolution computerized tomography (CT) can help to stage squamous cell carcinoma of the larynx. This study was undertaken to identify findings on CT scans that might predict the likelihood of radiation therapy (RT) alone, controlling the primary site disease without significant irradiation-related complications. Of 30 patients with T2-4 cancers of the larynx, 13 were classified as favorable and 17 were classified as unfavorable candidates for RT based on the CT criteria of transglottic spread, more than 25% pre-epiglottic space involvement, extensive paralaryngeal space spread, or cartilage involvement. Seven of 17 (41%) unfavorable patients had local recurrences, two are alive with cancer, three patients are dead of disease (DOD), and five had significant complication, but there was no evidence of recurrent cancer. In the favorable group, there were two local recurrences (15%), one distant metastasis, one patient is DOD, and one had a significant complication, but no recurrent cancer. These data may be used to more adequately select and inform patients with T2-4 squamous cell carcinoma of the larynx before RT.