ObjectiveTo investigate the feasibility of endoscopic surgery for radiationinduced sarcoma (RIS) in patients with nasopharyngeal carcinoma (NPC) and to analyze its clinical efficacy.MethodsA retrospective analysis was made on five NPC cases with RIS of nasopharynx and skull base.ResultsAll five patients received nasal endoscopic surgery under general anesthesia. Their related symptoms were improved postoperatively with no severe complications. Postoperative imaging showed residual tumor in 2 cases: one patient whose residual tumor involved the cavernous sinus died of intracranial invasion within 3 months; the other one died of respiratory failure due to brain stem compression 16 months after surgery. As for the 3 cases with negative postoperative imaging, one refusing chemoradiotherapy accepted endoscopic surgery successively for 4 times, and finally died of important organ failure 9 months after surgery. The other one case accepted postoperative radiotherapy and chemotherapy died of brain invasion, and the other patient who received two courses of radical radiotherapy finally died of multiple organ failure induced by radiation encephalopathy 20 months after oporation.ConclusionsRIS is a rare tumor with high malignancy and poor prognosis. For the patients with operation indications, surgical treatment should be the preferred method. Endoscopic surgery combined with postoperative chemoradiotherapy may improve the prognosis.