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Objective: To evaluate the efficacy and safety of definitive radiotherapy in selected patients with local recurrence of Kimura disease of the head and neck after surgery. Methods: This retrospective study collected the clinical data of 14 patients with postoperative recurrence of Kimura disease of the head and neck who received definitive radiotherapy at the First Affiliated Hospital of Fujian Medical University between 2006 and 2022. The radiation dose ranged from 28 to 40 Gy. Its efficacy and safety were analyzed. Results: During follow‐up, ranging from 17 to 168 months, local control was achieved in 13 (92.9%) of the 14 patients with postoperative recurrence. There were no serious late toxicities except for mild xerostomia in four (28.6%) patients; the patients' peripheral blood eosinophil count dropped from 1.73×109/L before treatment to 0.42×109/L after treatment, and the eosinophil percentage dropped from 20.64% to 9.78%. Both changes were statistically significant (p<0.001). Conclusions: The findings of the study suggest that definitive radiotherapy is a viable and effective alternative to repeated surgery for managing recurrent Kimura disease of the head and neck, with significant response rates and a good safety profile. Peripheral blood eosinophil counts and percentages serve as simple and reliable biomarkers for monitoring Kimura disease progression and treatment responses. [ABSTRACT FROM AUTHOR]