Of 30 nasopharyngeal carcinoma (NPC) cases seen from Jan. 1976 through Mar. 1984 at Tokyo Metropolitan Komagome Hospital, 19 previously untreated patients with more than 1-year follow-up were retrospectively investigated to confirm the effective treatment modality. The average age was 51 years; the ratio of male to female was 3.5:1. Fifteen were in stage IV, 3 in stage III, and 1 in stage II. These 19 patients were grouped into three treatment modalities: a) radiation +/- unplanned chemotherapy (RT +/- CM); b) radiation+unplanned cis-diamminedichloroplatinum (II)(CDDP)-based chemotherapy (RT + unplanned CDDP); and c) radiation + planned CDDP-based chemotherapy (RT + planned CDDP). Planned CDDP-based chemotherapy consisted of 20-50 mg/M2 CDDP, i.v. for 1 hr, 7.5-15 mg/body bleomycin (BLM), i.v. and/or 20-30 mg/body MTX, i.v. at weekly intervals with diuresis for at least 4 courses. Plasma platinum (Pt) concentration before and 1 hr after CDDP administration revealed a gradual increase due to accumulated protein-bound Pt, while free Pt remained transient. This regimen could be safely administered for at least 4 courses. The survival rate of RT + planned CDDP (n = 8) was 100% at maximum follow-up of 55 months, while RT +/- CM (n = 6) at maximum follow-up of 54 months and RT + unplanned CDDP (n = 5) at maximum follow-up of 38 months were 17 and 0%, respectively. Thus, we concluded that the most effective treatment modality for advanced NPC was RT+planned CDDP.