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Combined therapy centered on radiotherapy has significantly improved the 5-year overall survival rate of patients with locally advanced nasopharyngeal carcinoma, exceeding 80%. However, radiation temporal lobe injury remains a serious late complication. Despite advances in precision radiotherapy, its incidence is 5%\u201315%, considerably affecting the prognosis and quality of life of patients. Radiation temporal lobe injury is triggered by multiple mechanisms, including direct radiation-induced damage to neurons and glial cells, ischemia and hypoxia resulting from endothelial injury, and imbalanced immunoinflammatory responses dominated by M1 microglia. Importantly, radiation temporal lobe injury disrupts neuro-immune crosstalk, leading to a decrease in peripheral lymphocytes and natural killer cells, an increase in pro-inflammatory cytokines, and systemic immune suppression, thereby further increasing the risk of infection and tumor recurrence. This narrative review complies with the Scale for the Assessment of Narrative Review Articles. We systematically retrieved and organized published clinical and preclinical studies on radiation temporal lobe injury and comprehensively summarized the pathogenesis of radiation temporal lobe injury; its regulatory effects on immune function; and current prevention and treatment strategies, including precision radiotherapy optimization and drug intervention. 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