Nasopharyngeal carcinoma is an endemic disease within specific regions in the world. Radiotherapy is themain treatment. In recent decades, intensity-modulated radiation therapy has undergone a rapid evolution.Compared with two-dimensional radiotherapy and/or three-dimensional conformal radiotherapy, evidence hasshown it may improve quality of life and prognosis for patients with nasopharyngeal carcinoma. In addition,helical tomotherapy is an emerging technology of intensity-modulated radiation therapy. Its superiority indosimetric and clinical outcomes has been demonstrated when compared to traditional intensity-modulatedradiation therapy. However, many challenges need to be overcome for intensity-modulated radiation therapyof nasopharyngeal carcinoma in the future. Issues such as the status of concurrent chemotherapy, updatingof target delineation, the role of replanning during IMRT, the causes of the main local failure pattern requiresettlement. The present study reviews traditional intensity-modulated radiation therapy, helical tomotherapy,and new challenges in the management of nasopharyngeal carcinoma.