Background: The purpose of this study was to evaluate the benefit to be gained from the addition of local radiotherapy to systemic chemotherapy in patients with newly diagnosed metastatic nasopharyngeal carcinoma in endemic areas of Southern China.Methods: The data of patients with metastatic nasopharyngeal carcinoma (n = 649) were retrospectively analyzed: 313 patients received only chemotherapy and 336 received chemotherapy plus radiotherapy. The characteristics of the radiotherapy and

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... diotherapy groups were compared using the chi-square test or Fisher exact test. Survival was analyzed using the Kaplan–Meier method. A Cox proportional hazard model was used to identify the factors independently associated with survival.Results: Median follow-up was for 36 months. In univariate analysis, radiotherapy was significantly associated with improved survival (median OS 27 vs. 18 months; 5-year OS 36.4% vs. 20.1%; P < 0.001). In multivariate analysis, radiotherapy was an independent predictor of survival (HR, 0.65; CI, 0.53-0.79; P < 0.001). Other independent prognostic factors included number of metastatic organs, smoking, body mass index, hemoglobin, and N stage. In subgroup analysis, chemoradiotherapy was associated with improved survival in both the single-organ metastasis group (5-year OS, 38.5% vs. 25.1%; P < 0.001) and the multiorgan metastases group (5-year OS, 25.0% vs. 9.7%; P = 0.003).Conclusion: The addition of local radiotherapy to chemotherapy appears to improve survival in patients with metastatic nasopharyngeal carcinoma. Even patients with multiorgan metastases may benefit from radiotherapy.