This paper presents the radiotherapeutic management and results of 51 patients seen at the Massachusetts General Hospital from 1950 through 1981 with recurrent carcinoma of the nasopharynx after prior irradiation. For the early lesions, T1 and T2 at the time of recurrence, the 5-year actuarial survival rate after high dose radical re-irradiation was 50%. There were 7 patients who lived more than 10 years and of these, 3 more than 20 years. Low dose of irradiation for recurrent lesions is rarely effective and the benefits of palliation often short lived and such approach is therefore not recommended. Radiation therapy techniques must be carefully executed to avoid radiation therapy complications.