Contemporary imaging with endoscopic examination determines tumor extent and this is reflected in the revised staging system. Radiotherapy remains the primary treatment modality. The use of intensity-modulated radiotherapy aims at enhanced tumor control while reducing adverse effects. Concurrent chemotherapy has shown to improve survival, although its efficacy in endemic regions requires confirmation. Determination of circulating cell-free Epstein-Barr virus DNA might detect early recurrence. For patients who developed recurrence in the neck, surgery provides good salvage. For small tumor in the nasopharynx, good results can be obtained with reirradiation therapy, brachytherapy or surgery. The salvage option depends on the size and location of the tumor as well as the expertise available. The long-term effects of these treatment modalities might be significant.