Nasopharyngeal carcinoma (NPC) presents unique clinical and biological characteristics that distinguish it from other head and neck malignancies. It poses a great therapeutic challenge for many specialists. It is associated with Epstein–Barr virus (EBV) infection, genetic predisposition, and environmental risk factors. With advancements in radiotherapy and systemic therapy, new treatment options have emerged. We want to focus on contemporary therapeutic strategies for NPC, emphasizing breakthroughs in intensity-modulated radiotherapy (IMRT), chemoradiotherapy, targeted therapy, immunotherapy, and emerging cellular therapies. By integrating recent discoveries with clinical evidence, we aim to provide state-of-the-art information, along with a comprehensive understanding of current best practices, emerging treatments, and critical prognostic determinants in NPC.