Objectives Our study aimed to compare the efficacy and toxicity of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone in patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC). Design: Cohort Retrospective study Settings: Data of HPSCC patients collected from 2008 to 2020 Participants: 83 HPSCC patients Main outcomes measures: 83 patients with HPSCC in our center, who received IC followed by either CCRT or RT alone according to multidisciplinary team (MDT) discussion, were eligible for analysis. Among these patients, 52 patients underwent CCRT and 31 received RT alone after IC and we compared the two groups. Then we further compared the IC + CCRT and IC+RT groups in IC responders showing complete response (CR) and partial response (PR). Survival, toxicities clinical efficacy and outcomes were analyzed. Results For IC responders, IC+CCRT compared to IC+RT improved the locoregional relapse-free survival (LRPFS) (median: 39.3 vs.15.13 months; P=0.033), distant metastasis-free survival (DMFS) (median: 21.37 vs. 13.6 months; P=0.044), PFS (median: 27.87 vs.11.37 months; P=0.048) and the overall survival (OS) (median: 39.33 vs. 18.03 months, P=0.027). A multivariate analysis confirmed IC+CCRT was a positive prognostic factor for LRPFS and OS. However, for either all patients or IC non-responders, IC+CCRT did not improve the survival compared to IC+RT. Regarding acute toxicity, toxicities except ≥2 leucopenia were not statistically different between the two groups. Conclusion In the IC responders, CCRT may possess the survival benefit compared to RT alone in patients with HPSCC. Moreover, the toxicities of two groups were comparable during the therapy. Keywords hypopharyngeal carcinoma, induction chemotherapy, chemoradiotherapy, radiotherapy, survival