Summary Of 256 patients with advanced carcinoma of the nasopharynx, 82% presented with Stage IV disease. The 5-year survival was 15% with 83% failing within 2 years. Prognosis was related to stage ( p<0.003), neck status ( p<0.03), initial performance status ( p<0.001) and radiation dose ( p<0.003). With no pathological neck glands (N 0), less than 5% failed radiotherapy. Overall, 36% had distant metastases, correlating with the N Stage ( p<0.001) but not with the T Stage. The most frequent site of metastasis was lung, then bone and liver. Radical neck dissection failed to increase tumor control, contributing to three fatal complications. New radiotherapeutic regimens have so far failed to substantially improve the results.