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Objective The aim of this study was to evaluate the relationship between the pre-treatment Epstein-Barr viral DNA copy numbers in plasma and progression--free survival (PFS) and overall survival (OS) in a cohort of patients with stage Ⅱb-ⅣVb nasopharyngeal carcinoma.Methods We evaluated plasma samples from 36 patients treated with induction chemotherapy followed by chemoradiation.EBV copy numbers were determined after DNA extraction using real-time quantitative PCR.Survival curves were estimated using the Kaplan-Meier method.Results Circulating Epstein-Barr virus DNA levels were measured before treatment.Pretreatment levels significantly correlated with the initial stage and probability of relapse.Their increase was 71.4% sensitive in detecting loco-regional or metastatic recurrence.Three-year progression-free and overall survivals were respectively 78.2% and 97.1%.Conclusions The results of this study confirm that patients affected by loco-regionally advanced nasopharyngeal carcinoma have high plasma Epstein-Barr virus DNA levels at diagnosis.The monitoring of plasma levels is sensitive and highly specific in detecting disease recurrence and metastases.