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Radiation-induced sarcoma of the head and neck (RISHN) is one of long-term complications of radiotherapy. The rarity of this tumor is reflected in a few cases reported in the English language medical literature. The incidence of RISHN is, however, likely to increase due to progressive aging of the population combined with improved survival of head and neck cancer patients resulting from better treatment regimes. Diagnosis and management of this problem can be extremely challenging. We have experienced a case of spindle cell sarcoma arising in the nasopharynx of a 52-year-old who followed radiotherapy for nasopharyngeal undifferentiated carcinoma. So, we elaborate on it in our report with a review of literatures. To our knowledge, this is the first report about radiation-induced spindle cell sarcoma in Korea.