Objective To investigate the long-term outcomes of patients with nasopharyngeal carcinoma (NPC) in different stages treated by intensity-modulated radiotherapy (IMRT) and explore their treatment strategies. Methods A retrospective analysis was performed on the clinical data of 868 NPC patients without distant metastasis who received radical IMRT from May 2001 to October 2008. These patients were divided into early N₀(T_1－2N₀) group (n=137), early N₁(T_1－2N₁) group (n=129), locally advanced (T_3－4N_0－1) group (n=322), regionally advanced (T_1－2N_2－3) group (n=107), and locoregionally advanced (T_3－4N_2－3) group (n=173). There groups were compared in terms of treatment outcome and treatment strategy. Results The follow-up rate was 91.4%, and 314 patients completed 5-years follow-up. The 5-year overall survival rate, local recurrence-free rate, and distant metastasis-free rate (DMFR) were 83.5%, 91.8%, and 84.6%, respectively. The early N₀ group had the best treatment outcome, with a 5-year disease-specific survival (DSS) rate up to 99.1%. Each group had a similar outcome after receiving either IMRT alone or IMRT combined with chemotherapy. The locally advanced group and regionally advanced group had similar failure patterns and treatment outcomes. The locoregionally advanced group had the worst treatment outcome, with a 5-year DMFR of 67.2% and a DSS of 68.0%. The regionally advanced group and locoregionally advanced group had a similar treatment outcome after receivingIMRT alone, induction chemotherapy plus IMRT, or concurrent chemotherapy and IMRT. ConclusionsPatients with NPC in different stages have different survival outcomes. It is recommended that different treatment strategies should be adopted according to the T and N stages of NPC. IMRT alone can produce satisfactory results in patients with T_1－2N₀ NPC, but a more effective medication should be added to IMRT in patients with advanced NPC, particularly those with T_3－4N_2－3 NPC who have a relatively low DMFR.