Purpose <p>This study aimed to identify symptom clusters in survivors with nasopharyngeal carcinoma undergoing radiotherapy and to explore the interrelationships among these symptoms. Furthermore, it sought to identify core and bridge symptoms and to observe their changes over time.</p> Methods <p>A longitudinal study was conducted, recruiting 181 survivors newly diagnosed with nasopharyngeal carcinoma who were undergoing radiotherapy. Measurements were taken during weeks 1–6 of radiotherapy. Symptom assessment was conducted using the MD Anderson Symptom Assessment Scale – Head &amp; Neck Module. Symptom network analysis was performed at each time point, and centrality metrics were analyzed to explore the interrelationships among symptoms.</p> Results <p>Four stable symptom clusters were identified, with fatigue, feeling of being distressed, feeling sad, and difficulty swallowing/chewing as central symptoms, and feeling sad, feeling of being distressed, fatigue, and vomiting as bridge symptoms. The stability of the symptom network across the six time points was acceptable.</p> Conclusion <p>The symptom network results are crucial for developing future targeted symptom management interventions. Future research should focus on developing precise interventions targeting core and bridge symptoms to alleviate nasopharyngeal carcinoma survivors’ symptom burden.</p> Implications for Cancer Survivors <p>For nasopharyngeal carcinoma survivors undergoing radiotherapy, implementing a dynamic symptom management strategy with tailored interventions for core and bridge symptoms enhances symptom management efficiency, thereby improving survivors’ quality of life.</p>