Background: The locally advanced Head and neck cancer with fixed nodes are incurable and has a short survival. This study aims to evaluate the symptom relief, disease response and acute toxicity after palliative hypo fractionated radiotherapy.Methods: Between December 2010 to June 2011, previously untreated 50 patients who had histopathologically proved of Head and neck squamous cell carcinoma with fixed node of stage IV, Eastern Cooperative Oncology Group (ECOG) performance status 2-3 were offered palliative radiotherapy (20 Gy/5Fr/5 Days). Patients were evaluated at 15th and 30th day after completion of treatment for disease response (WHO), palliation of symptoms using symptomatic response grading and acute toxicities (Radiation Therapy Oncology Group, RTOG).Results: The most common presenting complaint was pain followed by dysphagia. Majority of patients (60-70%) had appreciable relief in their presenting symptom. In our study, we observed Partial Response (PR) in majority of patients (92%), no patient had progressive or stable disease. None of the patients experienced radiation toxicities that required hospital admission. Almost all patients showed grade one and two acute skin and mucosal toxicities one month after completion of treatment.Conclusion: Advanced Head and neck cancer with fixed neck node should be identified for suitable palliative hypo fractionated radiotherapy to achieve acceptable symptom relief in great proportion of patients.