This study aimed to evaluate survival in patients with locally advanced nasopharyngeal carcinoma. The records of 407 patients with locally advanced nasopharyngeal carcinoma treated retrospectively reviewed. Patients were treated with 5 different treatment protocols: 22.4% patients received radiotherapy, 16.4% received concomitant chemoradiotherapy, 11.3% received concomitant chemoradiotherapy + adjuvant chemotherapy, 30.7% received neoadjuvant chemotherapy + concomitant chemoradiotherapy, and 19.2% received neoadjuvant chemotherapy + radiotherapy. At the median follow-up of 64 months 5-year and 10-year overall survival were 64.6% and 55.3%, respectively, and 5-year and 10-year locoregional relapse-free survival were 58.5% and 49.2%, respectively. Age <40 years (p< 0.001) and early stage (p= 0.014) were associated with better survival. Among the treatment protocols, neoadjuvant chemotherapy + radiotherapy yielded the best survival (p= 0.001). Concomitant chemoradiotherapy was not associated with any survival advantage; however, the addition of chemotherapy to concomitant chemoradiotherapy prolonged survival, regardless of radiotherapy schedule. The present findings show that the addition of chemotherapy, especially neoadjuvantly, improved overall survival.