OBJECTIVES/HYPOTHESIS: Recent reviews of laryngeal cancer have detected a trend toward reduced survival, linked temporally to an abrupt change in treatment of these patients during the 1990s to nonsurgical regimens. Because organ preservation also is an important goal for hypopharyngeal cancer, we sought to determine treatment trends and survival data for patients with hypopharyngeal squamous cell carcinoma (SCC). STUDY DESIGN: Retrospective cohort. METHODS: Records of 6,647 patients with SCC of the hypopharynx between 1973 and 2003 were selected for review from the Surveillance, Epidemiology and End Results database, with comparison of 1973 to 1989 and 1990 to 2003 cohorts. RESULTS: Overall 5-year survival rates for hypopharyngeal cancer have improved. Average survival of hypopharyngeal cancer patients increased to 41.3% in those diagnosed 1990 to 2003 from 37.5% in those diagnosed 1973 to 1989 (P < 0.0001). Since 1990, there is a trend toward treatment using radiation without surgery (43.1% increased to 52.1%), combined surgical and radiation therapy is relatively unchanged (43.6% to 41.8%), and fewer patients underwent surgery alone (14% reduced to 7.3%). CONCLUSION: There has been a trend away from surgical therapy for hypopharyngeal SCC. In contrast to laryngeal cancer, survival for hypopharyngeal cancer has improved since 1990.