Background: Pediatric nasopharyngeal carcinoma (NPC), is rare but mostly presented in advanced stage. Our retrospective study aimed at evaluation of treatment outcome and toxicities. Patients and methods: The records of 24 eligible patients with NPC were reviewed during the period from January 2005and January 2015. Patients received 3 courses of chemotherapy regimen that consisted of cisplatin, 5-fluorouracil, with or without methotrexate followed (in non metastatic patients) by radiation therapy or chemo-radiotherapy. OS rates were estimated using the GraphPad prism program. The log- rank test was used to examine differences in OS rates. Results: The majority of patients presented with advanced stages (III&IV) (17, 71%), and showed response to treatment (CR&PR) (15, 63%). With a median follow up of 34 months (range: 3-120), the 3-year rate for OS was 58%. Univariate and multivariate analyses revealed that disease stage significantly affected survival. Conclusion:. The used treatment protocol resulted in favorable outcome, but was associated with late effects. High precision radiotherapy (IMRT or 3DCRT) are needed to improve the cure of advanced or recurrent disease and to reduce long-term morbidities.