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.