Hypofractionated Versus Conventionally Fractionated Radiotherapy for Initial Distant Metastases Nasopharyngeal Carcinoma

Inclusion Criteria:

1. Patients with newly histologically confirmed non-keratinizing (according to WHO histologically type) Tumor staged as any T or any N with M (according to the 8th AJCC edition).
2. No pregnant female
3. Age between 18-70
4. Normal complete blood count level (hemoglobin \>10 g/dL, white blood cells ≥4000/μL, platelets ≥100 000/μL)
5. Normal hepatic functions (serum total bilirubin ≤1.6 mg/dL, serum transminase \< 2.5 times higher than upper limit)
6. Normal renal function (serum creatinine ≤1.5 mg/dL, creatinine clearance ≥60 mL/min)
7. Karnofsky performance status (KPS) score of at least 70
8. Without radiotherapy or chemotherapy
9. Patients must give signed informed consent

Exclusion Criteria:

1. Other or mixed pathological type
2. age \> 70 years or \<18 years
3. Prior chemotherapy, radiation, surgical resection or target therapy of the primary tumor;
4. Significant medical or psychiatric illnesses that in the physician's judgment (uncontrolled coronary heart disease, cardiomyopathy and/or heart failure requiring hospitalization. Uncontrolled hypertension or history of myocardial infarction within one year. Uncontrolled diabetes mellitus. Acute bacterial or fungal infection requiring intravenous antibiotics;
5. Refused to sign informed consent form
6. Concurrent pregnancy or lactation
7. History of a second malignancy other than nasopharyngeal carcinoma