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Conclusions At our head and neck clinic, the high prevalence of grossly advanced malignant disease is largely due to patient-delay, aggravated by socio-economic difficulties and other hardships, such as the great distances that have to be covered to reach adequate treatment centres. Many of our patients have to come over a thousand miles for treatment and follow-up examinations. Ignorance on the part of the patient is profound and widespread. Judged by our experience of treating 82 patients with advanced head and neck cancer, intra-arterial infusion with methotrexate followed by deep X-ray therapy is a worthwhile palliative measure. In a few patients complete (albeit temporary) clinical regression was obtained. We are convinced that in disease recurring after radiotherapy the procedure is of little value and is probably not justified. We wish to acknowledge the permission of Dr. J. G. Burger, medical superintendent, to publish this paper; the encouragement of Prof. J. H. Louw and Mr. R. L. Forsyth; the help of Dr. S. T. de Kock, our anaesthetist, and the Africa Cyanamid Overseas Corporation’s very generous support. The work was supported by a grant from the Cancer Research Trust, Cape Town. The photo- graphs were prepared by Mr. B. Todt, head of the hospital medical illustration department.