Improvement in modern radiotherapy technique and the use of combined chemo-radiotherapy has significantly improved the local control of nasopharyngeal carcinoma (NPC).Local recurrence however remains an important cause of morbidity and mortality particularly in advanced T stage disease.Aggressive salvage treatment is generally recommended for local recurrence since long-term control can still be achieved in some patients.Several important prognostic factors have been identified in patients with recurrent NPC including recurrent T stage, time to recurrence and reirradiation dose.Over-expression of epidermal growth factor receptor also appears to predict poor outcome after salvage treatment.These factors are important and can be used to select patients for appropriate salvage treatment.When the recurrent tumor is confined to nasopharynx, both nasopharyngectomy and brachytherapy can be used with a long term control rate of 52-72%.Stereotactic radiotherapy can also be used in treatment of local failures of NPC with long term control of 53-86%.Patients with more extensive or bulky disease however often required external beam re-irradiation, but treatment outcome after the use of conventional radiotherapy was unsatisfactory with a five-year survival rate of 8%-36% and a high incidence of late complication.The use of intensity-modulated radiotherapy in retreatment of NPC allows better sparing of normal tissues while delivering high dose too the target.Preliminary reports using IMRT for reirradiation of NPC showed good short-term control with a relatively low incidence of severe late toxicities.The use of novel chemotherapy drugs, molecular targeted therapy and T cell based immunotherapy are promising in recurrent NPC and preliminary results will be presented.