Objective To evaluate the therapeutic effect and adverse reactions of fractionated stereotactic radiotherapy (FSRT) for the treatment of locally recurrent nasopharyngeal carcinoma after radiotherapy by the gamma ray stereotactic radiotherapy. Methods A total of 30 patients with recurrent nasopharyngeal carcinoma were divided into two groups (A group and B group) and treated by FSRT. The prescription dose at 50％ isodose line was 2 Gy each time and each patient consecutively underwent 5 treatments per week. The mean doses of A group (n=8) and B group (n=22) were 15 Gy and 40 Gy, respectively. Results The complete response (CR) and partial response (PR) rates of A group were 87.5% (7/8) and 12.5% (1/8) after being treated by FSRT for 3 months and the CR and PR rates of B group were 77.3% (17/22) and 22.7% (5/22). The follow-up time was 10-70 months and the median follow-up time was 26 months. The Karnofsky performance status scores for 95.2%（20/21） of the surviving patients were over 90. The one-year survival rate and local control rate of A group were 77.78% and 77.78% and two-year survival rate and local control rate were 51.85% and 77.78%. The one year survival rate and local control rate of B group were 90.23% and 90.23% and two-year survival rate and local control rate were 82.71% and 74.01%. Conclusion The local control effect of FSRT on locally recurrent nasopharyngeal carcinoma after

radiotherapy is good and it is worth further clinical studies.