INTRODUCTION: Comprehensive oncology services have recently been introduced in the Northern Territory (NT) enabling delivery of concurrent chemo-radiotherapy (CCRT) in locally advanced head and neck squamous cell carcinoma (LAHNSC). The purpose of this study is to assess feasibility, compliance and toxicity of CCRT in remote Australia. METHODS: Chart review was conducted for all patients >18 years, with biopsy-proven LAHNSC, receiving curative intent CCRT between January 2010 and September 2012. RESULTS: The study population comprised of 26 patients, 20 Caucasian and 6 Indigenous, having a median age of 58 years, with most common sites of involvement being the oropharynx (n = 16) and the oral cavity (n = 6). Major risk factors were smoking and alcoholism. Cardiovascular disease, viral hepatitis, latent tuberculosis and strongyloidosis were the major comorbidities. Fifty-eight per cent (n = 15) required assisted feeding. All patients received intensity modulated radiotherapy. Systemic therapy comprised of cisplatin or carboplatin/cetuximab. Most common acute (grade 3/4) toxicities were mucositis, dysphagia and dermatological in 54%, 31% and 23% respectively. Complications were infection and gastrostomy insertion related. Hospitalisation occurred in 23%, treatment break >2 days in 38%, with no difference in toxicities between indigenous and nonindigenous patients. Platinum use was associated with greater nausea (P = 0.003), renal dysfunction (P = 0.03) and ototoxicity (P = 0.04) and cetuximab with dermatological reactions (P = 0.05). At median follow-up of 16 months, overall survival was 58% with progression-free survival of 50%. CONCLUSIONS: We have demonstrated good compliance rates, tolerance and feasibility outcomes. The seeming preponderance of LAHNSC in the NT is cause for concern.