Der Umfang der Fernmetastasendiagnostik bei Kopf-Hals-Tumoren wird nach wie vor kontrovers diskutiert. In der vorliegenden retrospektiven Studie wurde anhand der Verläufe von 1087 Patienten mit primären Plattenepithelkarzinomen des oberen Aerodigestivtrakts untersucht, welche Faktoren die Häufigkeit und die Lokalisation einer Fernmetastasierung beeinflussen. Bei insgesamt 130 Patienten (12,0%) wurden zu Lebzeiten Fernmetastasen diagnostiziert, darunter 17mal (1,6%) zum Zeitpunkt der Primärtumordiagnose. Die Fernmetastasenrate korrelierte positiv mit dem initialen Tumorstadium (pppPPP<0.0005). The locations of primary cancers as well as histopathologic grading were not independent risk factors for the development of distant metastases. They mainly reflected different frequency distributions of stages. The lungs, liver and bones were the most common sites of metastatic disease, being involved in 68.5%, 23.8% and 20.0% of cases, respectively. Our findings show that at the time of initial presentation chest X-ray alone appears to be sufficient to exclude distant metastases from tumors classified as T1–3 N0. Further screening comprising abdominal ultrasound, bone scanning and/or CT scans of the thorax is particularly indicated for patients with advanced-stage disease, local and/or regional recurrences and second primaries below the clavicles. However, the individual decisions should consider whether the detection of distant metastases will significantly affect clinical management.