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To evaluate the characteristics and risk factors for locoregional recurrence in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).The clinical diagnosis and treatment data of 195 patients with NPC treated with IMRT from March 2005 to May 2010 (including 9, 24, 70, and 92 cases of stage I, II, III, and IV disease, respectively, according to the 7th edition American Joint Committee on Cancer staging criteria) were retrospectively analyzed. The Kaplan-Meier method was used for survival analysis, and logistic regression was used to conduct univariate and multivariate analyses.The 5-year recurrence rate was 10.8%, and the 5-year local and regional recurrence rates were 8.7% and 3.4%, respectively. Multivariate analysis showed that the short axis of the cervical lymph nodes (≥3 cm) was an influencing factor for regional lymph node recurrence after IMRT.In-field and high-dose region failures were the main patterns associated with local-regional recurrence, and nasopharyngeal recurrence was most commonly detected. Newly diagnosed patients with large cervical lymph nodes (short diameter ≥3 cm) should be carefully followed up considering regional lymph node recurrence.