Abstract: Objective To investigate the efficacy and toxicities for patients with locally advanced nasopharyngeal carcinoma（NPC）treated by helical tomotherapy（HT）in combination with raltitrexed plus nedaplatin chemotherapy（RN+HT）or with docetaxel plus nedaplatin chemotherapy（DN+HT）. Methods A total of 84 diagnosed local／regional advanced NPC patients from Mar 2011 to Apr 2015 were enrolled in this study，among whom 31 cases received RN+HT treatment（raltitrexed 2.5 mg／m2 iv，d1；nedaplatin in total 75 mg／m2 iv，d1-d5），and 53 cases received DN+HT treatment（docetaxel 35-40 mg／m2 iv，d1，d8；nedaplatin in total 75 mg／m2 iv，d1-d5）. All the patients were treated with chemotherapy for 2 cycles with 21 days as a cycle. Long-term efficacy and toxicities were compared between the two groups. Results The median follow-up period was 21.5 months of 84 patients. There were 1 case of local recurrence, 2 cases of distant metastasis，and 2 cases of death in RN+HT group. And in DN+HT group，there were 2 case of local recurrence，3 cases of distant metastasis and 3 cases of death. The 2-year survival rate of RN+HT and DN+HT groups was 93.5％and 94.3％（P＞0.05），and the 2-year progressionfree survival rate was 90.3％and 90.6％（P＞0.05）. The most common acute adverse reactions were 1-2 grade mucosa reaction，skin injury，hematologic toxicities，weight loss，parotid injury，sphagitis and nausea/vomitting. Nausea/vomitting was higher in DN+HT group than in RN+HT group（P＜0.05），and no differences were found in other adverse actions between the two groups（P＞0.05）. Chronic injuries included skin injury， subcutaneous fibrosis and xerostomia，and no differences were found between the two groups（P＞0.05）. Conclusion RN+HT is effective and well-tollerated for locally advanced NPC.