Abstract: Objective: To explore the effects of accelerated fractionated radiotherapy plus concurrent late-course chemotherapy on stage- Ⅲ and Ⅳa nasopharyngeal carcinoma (NPC). Methods: A total of 64 patients with stage- Ⅲ and Ⅳa NPC were randomized into two groups: the group of 32 patients receiving accelerated fractionated radiotherapy plus concurrent late-course chemotherapy (the combination group) and the group of 32 patients receiving radiotherapy alone (the control group). All of the patients in the two groups received a 6-day fraction treatment per week with treatments once per day at a dose of 180 to 190 cGy per fraction until a total dose of 7200～7980 cGy was reached. The combination group also began receiving PF (PDD+5-Fu) chemotherapy treatments when the total radiotherapy dose reached 3600 to 3800 cGy. Results: The complete response rate of the combination and control groups were 93.8% and 84.4% (P>0.05), and that of the neck tumors were 70.4% and 40.0% (P<0.05) respectively. The complete remission (CR) rates in the combination and control groups were 90.6% and 65.6% (P<0.05), and the 1-year metastasis rates were 15.6% and 40.6% (P=0.05), respectively. Conclusions: This study shows that accelerated fractionated radiotherapy combined with concurrent late-course chemotherapy can improve the short-term curative effect and decrease the probability of distant metastasis of stage- Ⅲ and Ⅳa NPC.