Objective: This study aimed to assess the efficiency of radiotherapy and evaluate its outcomes for elderly (>65 years) patients who have undergone treatment for nasopharyngeal carcinoma (NPC). Methods: Forty-five (male, 35; female, 10) elderly patients with a diagnosis of undifferentiated NPC who were treated at our institution between 1994 and 2012 were retrospectively evaluated. The primary endpoint was the relationship between the patients’ characteristics and overall survival (OS); progression-free survival (PFS), locoregional progression-free survival (LRPFS), and toxicity analysis were the secondary endpoints. Results: The patients had a median age of 74.2 years. At a median follow-up period of 64 months, the median OS, PFS, and LR-PFS were 45 (95% confidence interval [CI]: 5.887-84.113), 34 (95% CI: 0.0-70.504), and 45 (95% CI: 20.092-69908) months, respectively. The 2-, 3-, and 5-year OS rates were 61.5%, 53.1%, and 50.0%, respectively, and the 2-, 3-, and 5-year PFS rates were 57.6%, 46.8%, and 43.7%, respectively. Patients with T stage (T3-T4 vs.T1–T2) or N stage (N0–1 vs. N2) had significantly shorter OS (p<0.05), PFS (p<0.05), and LR-PFS (p<0.05) outcomes, respectively, which were also confirmed using a multivariate analysis (p<0.05). Conclusion: Our results demonstrated that the established prognostic factors, including T and N stages, were important prognostic indicators of NPC in elderly patients.