Nasopharyngeal carcinoma (NPC), which has the highest incidence in South China, is mainly treated by radiotherapy. However, the survival rate remains low. Angiogenesis is closely correlated with progress of NPC. Thus, the combination of anti-angiogenesis with radiation is an attractive strategy for NPC treatment. A heterogenic xenografted human NPC nude mice model was established to investigate the effect of pigment epithelium-derived factor (PEDF), a potent anti-angiogenic factor, and the combined effect of PEDF and radiotherapy on nasopharyngeal carcinoma. Pigment epithelium-derived factor remarkably suppressed the growth of NPC by 43.52% and decreased the tumor microvessel density (MVD). Pigment epithelium-derived factor had no effects on the proliferation and apoptosis of NPC cell lines by MTT and flow cytometry assay. However, PEDF decreased vascular endothelial growth factor (VEGF) in NPC cell lines by downregulation of hypoxia-inducible factor 1a, a crucial transcriptional factor for VEGF expression, as demonstrated by western blotting and immunofluorescent staining assay. Interestingly, irradiation alone could also effectively downregulate VEGF and MVD of xenografted tumor, which indicates that irradiation suppresses NPC not only by killing tumor cells but also through anti-angiogenesis. Furthermore, combined treatment of PEDF with irradiation enhanced the antitumor efficacy. The MVD and VEGF in the combined therapy were much less than in the treatment with PEDF or radiotherapy alone. Our observation demonstrated that the combination of PEDF with radiotherapy enhances the efficacy of the antitumor effect on NPC by the coordinated inhibition on angiogenesis, which implies the potential role of PEDF as an adjuvant agent for NPC treatment. (Cancer Sci 2011; 102: 1789-1798 N asopharyngeal carcinoma (NPC) is rare in most countries, with an age-adjusted incidence less than one per 100 000 population per year. However, the highest incidence is found in Southern China (25-30 per 100 000 population per year), especially among people of Cantonese ancestry.(1) Nasopharyngeal carcinoma has the highest incidence of distant metastasis among head and neck cancers.(2,3) Radiotherapy is the main strategy for NPC. With the improvement of modern imaging techniques and radiotherapy planning and delivery, the localregional control of this neoplasm has been improved. (4,5) Overall survival has also been improved with the addition of concurrent and adjuvant chemotherapy.(6,7) However, the incidence of relapse remains high. Therefore, the development of multidisciplinary therapeutic approaches to improve local-regional control and eradicate micrometastases is required. (8) Angiogenesis, the formation of new blood vessels from preexisting vessels, occurs physiologically in growth, development and pathologically in tumors, diabetic retinopathy, rheumatoid arthritis and regeneration.(9) Tumor growth and metastasis are angiogenesis dependent, therefore inhibiting tumor-induced angiogenesis is a promising strategy for the treatment...