Objective To evaluate the long-term outcomes of patients with advanced N-stage nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and the effects of IMRT combined with different chemotherapies on the patients′ prognosis. Methods A retrospective analysis was performed on the clinical data of 179 patients with advanced N-stage NPC who were admitted to our hospital from January 2001 to January 2008. Of the 179 patients, 33 received IMRT alone, and 146 received chemoradiotherapy (CRT). Among the 146 patients, 71 received concurrent chemoradiotherapy (CCRT), 66 received induction chemotherapy (IC) plus CCRT, and 9 received CCRT plus adjuvant chemotherapy (AC). Results The follow-up rate was 96.5%, and 133 patients were followed up for at least 5 years. The 5-year overall survival rate was 69.0%. The patients receiving IMRT alone and patients receiving CRT had 5-year overall survival rates of 47.7% and 73.7%(χ²=13.91, P=0.000), 5-year distant metastasis-free survival (DMFS) rates of 49.2% and 68.3%(χ²=4.97, P=0.026), relapse-free survival rates of 74.5% and 92.4%(χ²=9.87, P=0.002), and progression-free survival rates of 37.5% and 65.1%(χ²=11.65, P=0.001). Among the patients receiving CRT, those receiving CCRT, IC plus CCRT, and CCRT plus AC had similar survival rates. IC plus CCRT resulted in a significantly higher DMFS than IMRT alone (χ²=4.65, P=0.031). Conclusions The distant metastasis rate is still high in patients with advanced N-stage NPC after IMRT, for whom IC plus concurrent chemotherapy and IMRT may be a better treatment regimen.