BackgroundTo compare efficacy and toxicity of nimotuzumab versus cisplatin (CDDP) concurrent with intensity modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).MethodsWe retrospectively reviewed patients with NPC from September 2008 to November 2013. The synchronous regimens included h-R3/RT (nimotuzumab and radiotherapy) one time per week for 6–8 weeks and CDDP/RT (cisplatin and radiotherapy) every three weeks for 2–3 cycles. All patients in our analysis completed the planned IMRT and received TPF (docetaxel + cisplatin + 5-fluorouracil) neoadjuvant chemotherapy for two cycles.ResultsAmong the 302 NPC patients who were treated definitively with TPF neoadjuvant chemotherapy followed by IMRT concurrent with nimotuzumab or cisplatin at West China Hospital Sichuan University, 52 patients received h-R3/RT with complete clinical and follow-up data. Based on age, sex and tumor stage, 104 eligible patients were propensity-matched, with 52 patients in each treatment group (h-R3/RT and CDDP/RT). With a median follow-up of 50 months, the 5-year overall survival (OS) and progression-free survival (PFS) rates for the h-R3/RT vs. CDDP/RT treatment groups were 63.9% vs. 81.4% (p = 0.024) and 58.0% vs. 80.6% (p = 0.028), respectively. The h-R3/RT patients experienced less leukopenia and milder nausea and vomiting. In our sub-analysis, for stage II patients, no significant differences were found in OS and PFS, whereas milder nausea and vomiting were found in the h-R3/RT group (p = 0.046). Moreover, for patients older than 60 years, there were no statistically significant differences in OS and PFS, whereas milder nausea and vomiting was observed in the h-R3/RT group (p = 0.020).ConclusionsAlthough CDDP/RT remains the preferred choice for most patients with NPC, h-R3/RT may be a treatment option for the patients with stage II, older than sixty years old, and who are intolerable to cisplatin.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2974-x) contains supplementary material, which is available to authorized users.