Objective:To compare the efficacy between stereotactic radiotherapy (SRT) and intracavitary brachytherapy (brachytherapy) in residual tumor of nasopharyngeal carcinoma (NPC) after treating with conventional exteal beam radiotherapy. Methods:60 patients with residual tumor of NPC after radical exteal beam radiotherapy (range 68 to 72 Gy)were randomized into SRT group (27 patients) and brachytherapy group (33 patients). Patients in SRT group received boost treatment of 10-20 Gy, 2-3 fractions, once every other day; patients in brachytherapy group were treated with boost 10-20 Gy, 5 Gy per fraction, twice a week. Results:Efficacy in the near future:in SRT group, the complete recession (CR), partial recession (PR) and no change (NC) rates were 77.8% (21/27), 18.5% (5/27), 3.7% (1/27), respectively and the efficacy rate was 96.3% (CR + PR); in brachytherapy group:the CR, PR and NC rates were 75.8% (25/33), 18.2% (6/33), 6.1% (2/33),respectively and the efficacy rate was 93.9% (CR + PR). The efficacy rates of the above two groups were compared (x2=0.032, P ＞ 0.05). Long term efficacy:in SRT group, 1-year and 3-year survival rates were 96.3%, 66.5% respectively and the median live time was 48 months; in brachytherapy group:1-year and 3-year survival rates were 93.9%, 60.2% respectively and the median live time was 46 months. The survival rates of two groups were compared (X2= 0.172, P ＞ 0.05). Conclusion:Both boost techniques of SRT and brachytherapy had elevated efficacy in patients with residual tumor of NPC and there was no obvious difference between the efficacy of the near and long term in SRT and brachytherapy group.