旨在证明免疫治疗时代局部放疗对新发转移性鼻咽癌的益处是否仍然存在，以及哪些患者可以从放疗中受益。2017年5月至2021年10月期间，共有273名经组织病理学确诊的新发转移性鼻咽癌患者接受免疫化疗入组。有或没有随后对鼻咽和颈部进行调强放射治疗。我们比较了两组之间的无进展生存期、总生存期和安全性。此外，还进行了亚组分析并开发了评分模型，以确定适合放疗的患者。有 95 名患者（34.8%）单独接受免疫化疗，178 名患者（65.2%）接受免疫化疗加随后的局部放疗。中位随访时间为 18 个月，接受免疫化疗加后续放疗的患者具有较高的 1 年无进展生存率（80.6% 比 65.1%，P < 0.001）和总生存率（98.3% 比 89.5%，P） = 0.001）比单独接受免疫化疗的患者要高。在多变量分析和倾向评分匹配分析中保留了这种益处。主要在寡转移、EBV DNA低于20,200拷贝/mL以及免疫化疗后完全或部分复发的患者中更为显着。联合治疗增加了3级或4级贫血和放疗相关的毒性。免疫化疗加随后的局部放疗延长了新发转移性鼻咽癌的生存期，且毒性可耐受。基于寡转移、EBV DNA 水平和免疫化疗后反应的评分模型可以促进个体化管理。版权所有 © 2023。由 Elsevier Ltd 出版。

To demonstrate whether the benefit of locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma remains in the immunotherapy era and which patients can benefit from radiotherapy.A total of 273 histopathology-confirmed de novo metastatic nasopharyngeal carcinoma was enrolled between May 2017 and October 2021 if receiving immunochemotherapy with or without subsequent intensity-modulated radiotherapy to the nasopharynx and neck. We compared the progression-free survival, overall survival, and safety between the two groups. Additionally, subgroup analysis was conducted and a scoring model was developed to identify suitable patients for radiation.There were 95 (34.8 %) patients with immunochemotherapy alone, and 178 (65.2 %) with immunochemotherapy plus subsequent locoregional radiotherapy. With a median follow-up time of 18 months, patients with immunochemotherapy plus subsequent radiotherapy had higher 1-year progression-free survival (80.6 % vs. 65.1 %, P < 0.001) and overall survival (98.3 % vs. 89.5 %, P = 0.001) than those with immunochemotherapy alone. The benefit was retained in multivariate analysis and propensity score-matched analysis. Mainly, it was more significant in patients with oligometastases, EBV DNA below 20,200 copies/mL, and complete or partial relapse after immunochemotherapy. The combined treatment added grade 3 or 4 anemia and radiotherapy-related toxicities.Immunochemotherapy plus subsequent locoregional radiotherapy prolonged the survival of de novo metastatic nasopharyngeal carcinoma with tolerable toxicities. A scoring model based on oligometastases, EBV DNA level, and response after immunochemotherapy could facilitate individualized management.Copyright © 2023. Published by Elsevier Ltd.