Chemo-radiotherapy is the standard of care for organ preservation in stage three and four oropharyngeal cancer, prospective data on patients over 65 has not been available as they are usually excluded from randomised trials. This paper reviews the experience of a single institution on 32 patients aged between 65 and 87 (median 74). Karnofsky Performance score was >70 for all patients and co-morbidities that were adequately controlled with medical therapy were included. These co-morbidities included diabetes, coronary arterial disease, hypertension and stroke. Radiotherapy was delivered at 68-70Gy. In total 29 patients received platinum based chemotherapy, three received cituximab / nimotuzimab. Mean overall treatment time was 49.4 days (44-65 days). Response was assessed six to eight weeks after treatment was completed using RECIST criteria with toxicities measured against National Cancer Institute common toxicity criteria. Ninety percent of patients completed the planned doses of radiotherapy and at least five cycles of chemotherapy. This is higher than in other studies quoted. One patient developed septicaemia during the treatment and did not complete treatment. For acute toxicity, 6% patients experienced grade three skin toxicity, with 14 experiencing grade three mucosal toxicity. Significant late toxicity (grade 3>) was only seen in six percent of patients. Tumour response in the 31 patients completing treatment was evaluated six to eight weeks after treatment. Complete response was seen in 29 (77%) patients with partial response in seven. In the cohort of partial response, all received salvage chemotherapy and are still alive. Loco-regional control at two years was 72%, with survival at two years of 89%, better than previous studies. The authors conclude that radical chemo-radiation is a valid treatment for option for organ preservation in well elderly patients, with special emphasis on nutritional support and oral hygiene. Further stage III trials are needed to draw definitive conclusions.