Abstract: AIM: To evaluate the efficacy and safety of PLF and PFM regimen based on cisplatin plus 5-fluorouracil in recurrent or metastasis nasopharyngeal carcinoma(NPC) , and to explore prognostic factors of advanced NPC by survival analysis.METHODS: Patients with recurrent or metastasis NPC were enrolled in the study.They were nonrandomly assigned to receive a 2-hour infusion of folinic acid 200mg·m^-2 followed by a 5-FU bolus 400 mg·m^-2 and 48-hour infusion 3, 000mg·m^-2 combined with DDP25 mg·m^-2 on day 1 -3 every 3 weeks (PLF) or DDP25 mg·m-2 on day 1 -3,5-FU bolus 400mg·m^-2 on day 1 -5 plus pingyangmycin 5 mg·m^-2 on day 1, 3 and 5 every 3 weeks (PFM).RESULTS: 48 patients were enrolled.The total response rate was 63.83%, and the response rate of PLF 、PFM regimen was 76.92% and 47.62%(P=0.066, respectively.The main side effects include nausea, vomiting,alopecia, bone marrow suppression and mucositis.The DLF regimen was milder than DFM regimen in nauseavomiting(P=0.032).After a median follow-uPof 10 months, the overall median survival was 11.0 months,and the median survival of grouPA and grouPB were 12 and 9 months(P=0.3691) , respectively.A highly significant correlation was noted between poor-prognosis to severe anemia (Hb <10 g·L^-1 , P=0.001) before chemotherapy and the older patients (age ≥65, P=0.030) by Cox Regression analysis.CONCLUSION: The PLF regimen can be recommended for recurrent or metastasis NPC as first-line good treatment because its tolerable and more active.Anemia (Hb <10 g·L^-1) and older age (age≥65) indicate poor prognosis.

Key words: advanced nasopharyngeal carcinoma, leucovorin, 5-fluorouracil, cisplatin