Abstract: Objectives: Are LANC patients with carotid artery invasion are at risk of massive neck hemorrhage after radiotherapy? Design: This retrospective study aims to assess the efficacy of HT with CCRT +/-EGFR inhibitor in LANC patients invading carotid artery and risk of fatal bleeding. Settings: Otolaryngology Head and Neck Surgery department in our hospital in China . Participants: Of 130 LANC patients with carotid artery invasion admitted to our hospital between January 2012 and September 2019. Main outcome measures: The 5-year survival rate of three degrees of the carotid artery invasion (<180°, 180°≤IG<270°, ≥270°) . Univariate and Multivariate Cox regression analysis were used for survival correlation factors. Results: The incidence of fatal bleeding after radiotherapy was 2.3% (3/130). The primary site of the three cases were all the pharyngeal recess, with more than 270º carotid artery invasion. Patients with hemoglobin levels >110 g/L had a higher PFS, DMFS and OS than with that ≤110 g/L (P<0.05). Multivariate analysis showed that the EGFR inhibitor was an independent risk factor for PFS and DMFS, while the lowest hemoglobin level was an independent risk factor for OS. Conclusion: In LANC patients whose carotid artery invasion was <270º, HT combined with CCRT and EGFR inhibitor after induction chemotherapy had mild and tolerable side effects, better PFS and DMFS, with no massive hemorrhage. In patients ≥270º, diabetes with poor control or re-radiotherapy led to a higher risk of massive hemorrhage after radiotherapy.