BACKGROUND: External beam radiotherapy and surgery produce equivalent long-term survival and tumor control in early glottic cancer. The expense and cost of radiotherapy have been challenged. METHODS: A retrospective review was performed for 57 patients undergoing radiotherapy for glottic cancer. End points included local tumor control, relapse-free survival, cause-specific survival, medical charges, and costs. The results were compared with those of 265 patients who underwent transoral endoscopic removal or an open laryngeal procedure at the same institution. RESULTS: The local control, larynx preservation, re-treatment, voice quality, relapse-free survival, and cancer death results and medical charges and costs are reported by treatment. CONCLUSIONS: Radiotherapy provides at least equivalent, if not superior, local tumor control, larynx preservation, voice quality, and survival, compared with the surgical options. Overall medical charges and costs for radiotherapy are similar to transoral endoscopic resection and less than partial vertical laryngectomy.