Abstract: Objective To investigate the changes of serum anterior gradient-2 (AGR2) before and after intensive modulated radiation therapy (IMRT) combined with simultaneous TP regimen (paclitaxel, cisplatin) in patients with advanced nasopharyngeal carcinoma (NPC) and its predictive value. 
Methods A total of 51 patients with advanced NPC were treated with TP chemotherapy and IMRT radiotherapy for 4 cycles. The toxic reactions during simultaneous radiotherapy and chemotherapy and the short-term and long-term effects after treatment were recorded and compared. In the meantime, 30 healthy people were selected as the control group to observe the effect of serum AGR2 level on the prognosis of patients with advanced NPC before and after treatment. 
Results After simultaneous radiotherapy and chemotherapy, the total effective rate of patients with advanced NPC was 80.39%, of which complete remission (CR) was 41.18% and partial remission (PR) was 39.22%. The main adverse reactions were oropharyngeal damage (90.2%), myelosuppression (74.5%), leukopenia (68.6%), and thrombocytopenia (33.3%). After simultaneous radiotherapy and chemotherapy, the serum AGR2 level of the patients decreased significantly, which, however, was still significantly higher than that of the normal control group ［(13.28±4.17) μg/L vs. ( 8.85±1.98) μg/L］(P＜0.001). The serum AGR2 level of the effective group was significantly lower than that before treatment (13.28 μg/L vs. 24.18 μg/L) (P＜0.05). There was no significant difference between the ineffective group before treatment ［(33.81±8.12) μg/L］ and after treatment ［(24.77±6.93) μg/L］. The Kaplan-Meier curve showed that the median survival time of the patients in the low level AGR2 group was significantly longer and the prognosis was better than that in the high level AGR2 group (35.24 months vs. 31.73 months, P=0.039). 
Conclusion The level of AGR2 in the effective group of patients with advanced NPC treated with IMRT and TP regimen is significantly lower, and the prognosis of patients with low expression of AGR2 is better. 

Key words: nasopharyngeal carcinoma, chemoradiotherapy, anterior gradient-2