A retrospective study was performed on 966 patients with histologically verified nasopharyngeal carcinomas. The follow-up rate was 93.6% over a minimum period of five years. The actuarial and relapse-free survivals were 82% and 49% at one year, 64% and 43% at two years, 43% and 33% at five years, and 36% and 22% at ten years, respectively. None of the patients with distant metastases when initially evaluated survived more than four years following the initiation of radiotherapy and chemotherapy. After the initial radiotherapy was completed, 200 (22.2%) of 900 patients had distant metastases, bone metastases being the most frequent; and 226 (25.1%) patients had locoregional recurrence. There is no statistical correlation found between locoregional recurrence and distant metastases. In patients without recurrence, the rate of subsequent distant metastases is found to be much more heavily influenced by the initial N stage (trend X2 P less than 0.001) than the initial T-stage (trend X2 0.05 greater than P greater than 0.02). Of patients with metastases, the survival time of those with liver metastases was found to be the shortest, 5.4 +/- 0.5 months (mean +/- SEM). Since three quarters of both distant metastases and recurrence developed within two years of the initial radiotherapy, it is highly recommended for patients to be examined monthly during this period. Aggressive retreatment may lead to palliation should recurrence and/or distant metastases be found. Adjuvant chemotherapy is recommended to the patients with T4, N2 or N3 disease following completion of the initial radiotherapy.