During a 20-year period, we treated 26 patients with radiation after total laryngectomy because of laryngeal cancer with subglottic extension (LCSE). The paratracheal lymph nodes superior (and inferior in two cases) to the suprasternal notch were irradiated in addition to the primary tumour bed. With a follow-up period ranging from 5 to 185 months, the occurrence of neoplastic disease in the upper mediastinum was not observed in a single case. The rates of recurrent tumour in the neck and distant metastasis were both 8%. The 6-year survival rate was 67%. The observed results lead us to the conclusion that even with non-irradiation of the superior mediastinal paratracheal lymph nodes, postoperative radiotherapy can achieve reasonable long-term disease-free survival in patients with LCSE.