Benefit of Changing Chemoradiotherapy Sequence and Modifying Radiotherapy Schedule for Advanced Nasopharyngeal Cancer

Inclusion Criteria:

• Histologically proven nasopharyngeal carcinoma
• Non-keratinizing or undifferentiated type Stage III-IVB (by AJCC/UICC 6th edition)
• Essential staging investigations: CT or MRI of nasopharyngeal region Chest x-ray (or CT thorax)
• Liver function test, alkaline phosphatase Liver and bone scan if alkaline phosphatase exceeds the institutional upper limit of normal, or if clinically indicated.
• Liver scan if SGOT exceeds the institutional upper limit of normal
• Adequate marrow: WBC > 4 and platelet > 100
• Adequate renal function: creatinine clearance > 60 ml/min.
• Satisfactory performance status: > 2 by ECOG System.

Exclusion Criteria:

• WHO Type I squamous cell carcinoma or adenocarcinoma
• Age > 70
• Treatment with palliative intent (including those with tumor extent mandating the use of AP opposing facio-cervical field technique)
• Prior malignancy except adequately treated basal cell or squamous cell skin cancer, in-situ cervical cancer, or other cancer for which the patient has been disease-free for five years.
• Pregnancy or lactation (consider pregnancy test in women of child-bearing age and emphasize effective contraception during the treatment period).
• History of previous RT (except for non-melanomatous skin cancers outside intended RT treatment volume).
• Prior chemotherapy or surgery (except diagnostic) to primary tumor or nodes.