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Sites included were oropharynx (<jats:italic>n<\/jats:italic> = 39), oral cavity (<jats:italic>n<\/jats:italic> = 8), larynx (<jats:italic>n<\/jats:italic> = 8), hypopharynx (<jats:italic>n<\/jats:italic> = 8), and unknown primary (<jats:italic>n<\/jats:italic> = 6). Forty\u2010six patients received definitive IMRT (66 Gy, 2.2 Gy\/fraction), and 23 patients received postoperative IMRT (60.2 Gy, 2.15 Gy\/fraction). Fifty\u2010one patients also received concomitant chemotherapy. Posttreatment salivary gland function was evaluated by a validated xerostomia questionnaire in 29 IMRT and 75 matched CRT patients &gt;6 months after completing radiation treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>At a median follow\u2010up of 25 months for living patients (range, 10\u201360), 7 locoregional failures were observed, 5 in the gross target or high\u2010risk postoperative volume, 1 in the clinical target volume, and 1 at the junction of the IMRT and supraclavicular fields. The 2\u2010year Kaplan\u2013Meier estimates for locoregional control and overall survival were 92% and 74% for definitive IMRT and 87% and 87% for postoperative IMRT patients, respectively. The mean total xerostomia questionnaire score was significantly better for IMRT than for CRT patients (<jats:italic>p<\/jats:italic> = .006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>The predominant pattern of failure in IMRT\u2010treated patients is in the gross tumor volume. Parotid sparing with IMRT resulted in less subjective xerostomia and may improve quality of life in irradiated HNSCC patients. \u00a9 2006 Wiley Periodicals, Inc. 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