Objective To evaluate the treatment effect of later course accelerated hyperfractionated radiotherapy with chemotherapy for stage Ⅲ and ⅣA nasopharyngeal carcinoma. Methods 116 patients with stage Ⅲand Ⅳ s nasopharyngeat carcinoma were randomly divided into three groups: the conventional fractionation radiotherapy(CFR, 38 cases), the concurrent radiochemotherapy group(CCRT, 39 cases) and the later course accelerated hyperfractionated radiotherapy combined with chemotherapy group (LCAF+CT, 39cases). CFR group was treated with 60Co γ rays and X rays. When the patients had received the dose of 36～38 Gy through composite faciocervical fields, changed into preauricular fields, the total dose was 70 ～75 Gy.And the total dose of cervical metastasis lymph nodes were 70～80 Gy. CCRT group was treated with DDP and 5-Fu. LCAF+CT group was treated with accelerated hyperfractionated radiotherapy. When the dose of composite faciocervical fields had reached 36～38 Gy, changed the fields and treated with accelerated hyperfractionated radiotherapy, 1.3 Gy/fraction, twice daily. The total dose was 69.8～75 Gy. And the chemotherapy drugs was similar to CCRT group. Results The positive response rate among LCAF+CT, CCRT and CFR groups were 94.9 %, 89.7 %, 76.3 % respectively. The complete response rate in the nasopharyn of LCAF+CT group was higher than CFR group(P ＜0.05). The local control rates of one, two and three year of three groups were 100 %, 97.4 %, 89.5 %, 94.9 %, 84.6 %, 68.4 % and 89.7 %, 74.4 %, 57.9 %respectively; and the survival rates of one, two and three year of three groups were 100 %, 92.3 %, 84.2 %;89.7 %, 84.6 %, 71.0 % and 79.5%, 76.9 %, 57.9 % respectively. There were obvious difference between LCAF+CT and CCRT groups in local control rate and survival rate. But there were no difference between LCAF+CT group and CCRTgroup, and also between CCRT group and CFR group. Conclusion The later course accelerated hyperfraetionated radiotherapy combined with chemotherapy can promote disappearance of primary lesion and improve the local control rate and survival rate of patients with stage Ⅲand ⅣA nasopharyngeal carcinoma.