Head and neck squamous cell carcinoma (HNSCC) significantly impacts patients’ quality of life (QoL). This study investigated long-term QoL outcomes among 619 patients with newly diagnosed HNSCC over five years. QoL was assessed annually using the SF-36, covering physical functioning, emotional well-being, social functioning, pain, and general health. Patients were stratified by tumor subsite and smoking status. Significant improvements in QoL were observed at the 1-year follow-up, particularly among patients with pharyngeal [adjusted β: 3.56 (95

Introduction:Sinonasal teratocarcinosarcoma (SNTCS) is an aggressive and highly recurrent tumor with a predilection for anterior skull base location. It continues to pose a challenge due to difficulty in diagnosis and the lack of large-scale studies on optimal treatment strategies. Case Presentation:We report a case of a 48-year-old female patient who presented with headache, nausea, and vomiting. Initial imaging revealed a 6.4 × 4.5 cm extra-axial mass in the right frontal region, originating from the superior right nasal cavity. She underwent surgical resection of the tumor and was found to have SNTCS. She received concurrent chemoradiotherapy. Next-generation sequencing showed mutations in the PTEN, SMARCA4, and CCND1 genes. Six months after completion of treatment, she experienced an aggressive leptomeningeal recurrence of her disease. To our knowledge, our case represents the first SNTCS case with a documented PTEN mutation. In the absence of evidence-based guidelines due to the rarity of this diagnosis, we have reviewed over 50 cases reported in the literature. Conclusion:SNTCS remains challenging to treat, as despite using surgical resection and concurrent chemoradiotherapy, it continues to have a high recurrence and mortality rate. We further discuss various demographics, chemotherapy regimens, prognosis, and common genetic mutations found in SNTCS.

BACKGROUND:Post-diagnosis smoking remains prevalent among head and neck squamous cell carcinoma (HNSCC) patients. Smoking cessation may improve patient outcomes. METHODS:A prospective longitudinal cohort study (2008-2014) included 835 newly diagnosed HNSCC patients and followed up for 7 years. Participants were categorized by smoking behavior (never smokers, former smokers, quitters, continuing smokers, and intermittent smokers). The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). RESULTS:Smoking cessation after diagnosis was associated with significantly improved OS. Quitters had a 61% reduction in mortality risk compared to continuing smokers (HR: 0.39, 95% CI: 0.22, 0.69), with the greatest benefit in oral cavity cancer patients (HR: 0.28, 95% CI: 0.12, 0.65). Intermittent smokers also showed improved survival (HR: 0.50, 95% CI: 0.31, 0.79). RFS did not significantly differ based on smoking behavior. CONCLUSIONS:Smoking cessation post-diagnosis improves OS, particularly in oral cavity cancer patients, highlighting the importance of targeted smoking cessation interventions in HNSCC care.

The rising incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) necessitates advancements in risk stratification to optimize treatment outcomes and improve the quality of life for patients. Despite its favorable prognosis compared to HPV-negative OPSCC, current clinical staging and biomarkers, such as p16 status, are limited in their ability to distinguish between high- and low-risk patients within HPV-associated OPSCC. This limitation results in the overtreatment of low-risk patients, exposing them to unnecessary toxicity, and the undertreatment of high-risk patients who require more aggressive interventions. This review critically evaluates current stratification methods, including clinical assessments, de-escalation trials, and candidate molecular biomarkers for risk stratification. Emerging approaches such as immune markers, viral genomic integration patterns, and other molecular markers offer promising avenues for enhanced prognostic accuracy. By integrating advanced risk stratification methods, tailored treatment approaches may one day be developed to balance oncologic efficacy with reduced treatment-related morbidity. This review underscores the need for continued research into predictive biomarkers and adaptive treatment strategies to better address the diverse risk profiles of HPV-associated OPSCC patients.

Radiation therapy in one form or the other has an important role in the treatment of thyroid cancer. In the definitive setting, external beam radiation therapy is used in situations where microscopic or gross residual disease after thyroidectomy cannot be effectively treated with radioactive iodine or with targeted therapy. In patients with metastatic disease to the lungs, bone, brain, or other organs, different types of radiation can be administered depending on the clinical situation of the patient.

AbstractObjectivesOur study aims to determine the incidence and potential risk factors for cerebral radiation necrosis (CRN) following treatment of sinonasal malignancies.MethodsOne hundred thirty‐two patients diagnosed with sinonasal malignancies over an 18‐year period were identified at two institutions. Forty‐six patients meeting inclusion criteria and treated with radiation therapy were included for analysis. Demographic and clinical‐pathologic characteristics were collected and reviewed. Post‐treatment magnetic resonance imaging (MRI) at least 1 year following treatment was reviewed to determine presence or absence of CRN.ResultsCRN was identified on MRI in 8 of 46 patients (17.4%) following radiation treatment. Patients with a history of reirradiation were more likely to develop CRN (50% vs. 10.5%, p < .05). The BEDs of radiation were also higher in CRN patients compared to non‐CRN patients, but this difference was not significant (p > .05). CRN patients had a higher proportion of tumors with skull base involvement than non‐CRN patients (100% vs. 57.9%, p = .037). Demographics, comorbidities, pathology, primary tumor subsite, chemotherapy use, and stage of disease demonstrated no significant increase in risk of CRN.ConclusionsReirradiation and tumor skull base involvement were significant risk factors associated with CRN. Higher average total prescribed and BEDs of radiation were seen in the CRN groups, but these differences were not statistically significant. Gender, comorbidities, tumor subsite, tumor location, and treatment type were not significantly different between groups.Level of evidenceLevel 3.

Objective: The incidence and risk factors for facial nerve dysfunction (FND) following CyberKnife (R) therapy for vestibular schwannoma (VS) remain poorly understood. This study investigates whether differential radiation doses to vulnerable segments of the facial nerve may be associated with FND outcomes. Methods: Patients were identified who underwent CyberKnife (R) radiosurgery for VS at a single institution. Basic demographics, tumor characteristics, and facial nerve function were collected. Total radiation doses to tumor, internal auditory canal (IAC), and labyrinthine segment of facial nerve (LSFN) were evaluated. Results: Six out of 64 patients experienced FND following CyberKnife (R) treatment for VS (9.38%, 6/64). Patients with FND were compared to those without FND (control). Of the 64 patients, complete radiation records were obtained for 30 patients (6 FND vs. 24 control). There were no significant differences in demographic or tumor characteristics between control and FND cohorts. More severe FND (HB >= 4) had significantly larger tumors (3.74 vs. 1.27 cm(3), p = 0.037) with directionally decreased time to FND (3.50 vs. 33.5 months, p = 0.106) than patients with HB < 4, respectively. There were directionally, nonsignificant differences between maximum radiation doses to the LSFN (2492.4 vs. 2557.0 cGy, p = 0.121) and IAC (2877.3 vs. 2895.5 cGy, p = 0.824) between the control and FND cohorts, respectively. Conclusions: FND may represent an underrecognized sequelae of CyberKnife (R) radiosurgery for VS that can occur many months following treatment. Further studies are needed to elucidate the effect of differential radiation exposure to the facial nerve with FND following treatment.

Introduction: Extracranial meningiomas are an extremely rare entity, accounting for less than 1% of all meningiomas.1 Involvement of the ear and temporal bone is an even rarer clinical subset, with less than 100 cases reported in the literature and no definitive treatment paradigm recommended.2

Abstract MGMT promoter methylation status is an important predictive biomarker for treatment response in glioblastoma. MGMT unmethylated glioblastoma has elevated levels of MGMT which ultimately leads to chemoresistance. Clinicians consider the MGMT methylation status when treatment recommendations are given, and clinical trials use this marker for the selection of a homogenous group of glioblastoma patients based on prognosis. Here, we present a case of multifocal glioblastoma with heterogeneous MGMT methylation status. A 56-year-old male presented with left leg weakness for 2 months and left arm weakness for 1 month. Imaging revealed a calcified, rim enhancing right temporoparietal cystic lesion and a heterogeneously enhancing right parietal mass. Perilesional edema surrounded and connected the two lesions. The patient underwent gross total resection of the parietal mass and pathology revealed a WHO grade 4 glioblastoma, IDH wildtype, unmethylated tumor. Postoperatively, the patient was neurologically intact. He completed a 6-week long course of concomitant chemoradiation without any significant side effects. Two weeks later the patient developed rapidly worsening headaches, nausea, vomiting, dizziness, and left side weakness. Imaging revealed significant enlargement of the previously unresected temporoparietal cystic lesion with marked increase in surrounding edema and a 2-3 mm right to left midline shift. Patient underwent craniotomy with cyst drainage and tumor resection of the right cystic temporoparietal lesion, demonstrating a WHO grade 4 glioblastoma, IDH wildtype, methylated tumor. Post-operatively the patient was again neurologically intact and started adjuvant temozolomide. MGMT methylation status of glioblastoma can alter recommendations for chemotherapy with temozolomide. MGMT methylation status might vary in distinct parts of the tumor as molecular heterogeneity is a hallmark of glioblastoma. This heterogeneity should be considered by clinicians when treatments are recommended and by clinical trials for glioblastoma patients, especially when multifocal lesions have a distinct radiographic appearance.

Introduction: Review the early experience with a single-room gantry mounted active scanning proton therapy system. Material and Methods: All patients treated with proton beam radiotherapy (PBT) were enrolled in an institutional review board-approved patient registry. Proton beam radiotherapy was delivered with a 250 MeV gantry mounted synchrocyclotron in a single-room integrated facility within the pre-existing cancer center. Demographic data, cancer diagnoses, treatment technique, and geographic patterns were obtained for all patients. Treatment plans were evaluated for mixed modality therapy. Insurance approval data was collected for all patients treated with PBT. Results: A total of 132 patients were treated with PBT between March 2018 and June 2019. The most common oncologic subsites treated included the central nervous system (22%), gastrointestinal tract (20%), and genitourinary tract (20%). The most common histologies treated included prostate adenocarcinoma (19%), non-small cell lung cancer (10%), primary CNS gliomas (8%), and esophageal cancer (8%). Rationale for PBT treatment included limitation of dose to adjacent critical organs at risk (67%), reirradiation (19%), and patient comorbidities (11%). Patients received at least one x-ray fraction delivered as prescribed (36%) or less commonly due to unplanned machine downtime (34%). Concurrent systemic therapy was administered to 57 patients (43%). Twenty-six patients (20%) were initially denied insurance coverage and required peer-to-peers (65%), written appeals (12%), secondary insurance approval (12%), and comparison x-ray to proton plans (8%) for subsequent approval. Proton beam radiotherapy approval required a median of 17 days from insurance submission. Discussion: Incorporation of PBT into our existing cancer center allowed for multidisciplinary oncologic treatment of a diverse population of patients. Insurance coverage for PBT presents as a significant hurdle and improvements are needed to provide more timely access to necessary oncologic care.

Treatment of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) with initial surgical resection followed by adjuvant radiotherapy yields high cure rates, but can cause long-term toxicity. This phase II trial evaluated whether omitting high dose radiation to the resected primary tumor bed while targeting only the regional neck nodes, could maintain high local control rates while reducing late sequelae. Eligible patients were those appropriate for adjuvant RT after surgical resection for p16-positive, pathologic stage III-IVa (7th edition) p16-positive OPSCC. Pathologic inclusion criteria included: T1-T2 disease, any N1-2, negative resection margins, and no perineural or lymphovascular invasion. Patients received 60-66 Gy RT over 30-33 fractions to the regional nodes of the bilateral neck, with active omission of high-dose RT to the resected primary tumor bed. Concurrent chemotherapy was given for patients with extranodal extension. The primary end point was 2-year locoregional control. Sixty patients were enrolled. Thirty-two (53%) received intensity-modulated radiation therapy (IMRT), 27 (45%) received proton therapy, and 1 (2%) received a 50:50 hybrid IMRT:proton plan. Average follow-up was 2 years, with local control of 98%, regional control of 100%, distant control of 97%, and overall survival of 100%. Median dose delivered to the avoided primary site was 37 Gy (40 Gy for IMRT, 34 Gy for proton RT, p = 0.03). There was only 1 local recurrence, occurring 9 months after completion of RT, which was successfully salvaged via surgical resection. Two (3%) patients experienced post-RT primary site tissue necrosis, both of whom experienced complete resolution with conservative management. Percutaneous endoscopic gastrostomy (PEG) tube dependence rates were: 0 patients (0%) during RT, and 1 patient (2%) at time of last follow-up. Avoidance of radiation to the resected primary tumor bed appears safe in well-selected patients with HPV-associated OPSCC. This approach resulted in a low rate of treatment-associated complications, and is worthy of further study as a strategy for deintensification.

Traditional cancer models including cell lines and animal models have limited applications in both basic and clinical cancer research. Genomics-based precision oncology only help 2–20% patients with solid cancer. Functional diagnostics and patient-derived cancer models are needed for precision cancer biology. In this review, we will summarize applications of conditional cell reprogramming (CR) in cancer research and next generation living biobanks (NGLB). Together with organoids, CR has been cited in two NCI (National Cancer Institute, USA) programs (PDMR: patient-derived cancer model repository; HCMI: human cancer model initiatives. HCMI will be distributed through ATCC). Briefly, the CR method is a simple co-culture technology with a Rho kinase inhibitor, Y-27632, in combination with fibroblast feeder cells, which allows us to rapidly expand both normal and malignant epithelial cells from diverse anatomic sites and mammalian species and does not require transfection with exogenous viral or cellular genes. Establishment of CR cells from both normal and tumor tissue is highly efficient. The robust nature of the technique is exemplified by the ability to produce 2 × 106 cells in five days from a core biopsy of tumor tissue. Normal CR cell cultures retain a normal karyotype and differentiation potential and CR cells derived from tumors retain their tumorigenic phenotype. CR also allows us to enrich cancer cells from urine (for bladder cancer), blood (for prostate cancer), and pleural effusion (for non-small cell lung carcinoma). The ability to produce inexhaustible cell populations using CR technology from small biopsies and cryopreserved specimens has the potential to transform biobanking repositories (NGLB: next-generation living biobank) and current pathology practice by enabling genetic, biochemical, metabolomic, proteomic, and biological assays, including chemosensitivity testing as a functional diagnostics tool for precision cancer medicine. We discussed analyses of patient-derived matched normal and tumor models using a case with tongue squamous cell carcinoma as an example. Last, we summarized applications in cancer research, disease modeling, drug discovery, and regenerative medicine of CR-based NGLB.

PURPOSE:This trial tested the safety and efficacy of a novel, deintensified radiation therapy (RT) approach after initial surgical resection for patients with human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS AND MATERIALS:This single-arm phase 2 prospective clinical trial enrolled 60 patients with stage pT1-pT2 N1-3 HPV-associated OPSCC treated with transoral robotic surgery (TORS) and selective neck dissection at a single institution between May 2014 and September 2017. Patients had favorable features at the primary site (negative surgical margins ≥2 mm, no perineural invasion, and no lymphovascular invasion) but required adjuvant therapy based on lymph node involvement. Surgeries were all performed at a high-volume head and neck cancer center with expertise in TORS. Patients received postoperative RT to at-risk areas in the involved neck (60-66 Gy) and uninvolved neck (54 Gy). The resected primary site was treated as an active avoidance structure in the treatment planning of postoperative RT. Concurrent chemotherapy was administered for patients with extranodal extension. RESULTS:Median follow-up of the 60 patients enrolled was 2.4 years (range, 8.5-53.8 months). A single patient recurred at the primary site, for 2-year local control of 98.3%. One patient (1.7%) developed a regional neck recurrence, and 2 patients (3.3%) developed distant metastases. Measured 2-year local recurrence-free survival was 97.9% (95% confidence interval, 86.1%-99.7%). Overall survival was 100% at the time of analysis. The mean radiation dose to the primary site was 36.9 Gy (standard deviation, 10.3 Gy). Two patients (3.3%) experienced late soft tissue necrosis in the primary site surgical bed that resolved within 2 months. Feeding tube dependence rates were 0% during RT, 3.3% temporarily during follow-up, and 0% at last follow-up. CONCLUSIONS:Deintensified postoperative RT that avoids the resected primary tumor site and targets only the at-risk neck after TORS for selected patients with HPV-associated OPSCC may be safe and is worthy of further study.

PURPOSE:Quality of life (QOL) for patients with oropharyngeal squamous cell cancer is negatively affected by conventional radiation (RT) owing to radiation exposure to normal tissues. Proton therapy, via pencil beam scanning (PBS), can better spare many of these tissues, and may thereby improve QOL.PATIENTS AND METHODS:Patient-reported outcomes were prospectively collected from patients treated from April 2013 to April 2015. Patients were treated with PBS or intensity-modulated radiation therapy (IMRT) via volumetric arc therapy after transoral robotic surgery. Validated QOL questionnaires were collected before RT, and 3, 6, and 12 months post RT.RESULTS:Sixty-four patients were treated with adjuvant RT after transoral robotic surgery, 33 (52%) with volumetric arc therapy, and 31 (48%) with PBS. Both groups were similar in terms of age, site, stage, and dose delivered. Patients receiving PBS had significantly less dose to many normal structures than those receiving IMRT. These dosimetric advantages with PBS were reflected in higher scores in head and neck specific, as well as general, QOL measures. Most notable was significantly less xerostomia with PBS, on multiple patient-reported outcomes at multiple timepoints (6 and 12 months).CONCLUSION:Pencil beam scanning, when compared to IMRT, confers a significant dosimetric advantage to many normal organs at risk, with a corresponding benefit in multiple patient-reported QOL parameters in patients receiving adjuvant RT for oropharyngeal squamous cell cancer.

Lazarev et al investigated a novel approach to de-intensifying treatment of tonsillar cancer after transoral robotic surgery (TORS): targeting the neck with radiation therapy while omitting the primary site. [1] Lazarev S. Todorov B. James Tam, et al. Adjuvant radiation in the TORS era—Is there a benefit to omitting the tumor Bed?. Pract Radiat Oncol. 2017; 7: 93-99 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The rationale for this strategy is that tumors rarely recur in the primary bed following a negative-margin resection. 2 Cohen MA Weinstein GS O’Malley Jr., BW Feldman M Quon H Transoral robotic surgery and human papillomavirus status: Oncologic results. Head Neck. 2011; 33: 573-580 Crossref PubMed Scopus (180) Google Scholar , 3 Weinstein GS Quon H Newman HJ et al. Transoral robotic surgery alone for oropharyngeal cancer: An analysis of local control. Arch Otolaryngol Head Neck Surg. 2012; 138: 628-634 Crossref PubMed Scopus (158) Google Scholar Adjuvant radiation in the TORS era: Is there a benefit to omitting the tumor bed?Practical Radiation OncologyVol. 7Issue 2PreviewTrans-oral robotic surgery (TORS) followed by adjuvant radiation therapy (RT) is becoming popular in treating node-positive tonsillar squamous cell carcinoma (SCC). One potential benefit is eliminating irradiation of the primary site when the tumor is widely resected, and targeting the neck only. This study assessed whether omitting the tumor bed provides any dosimetric or clinical advantage. Full-Text PDF

Most contemporary researches in low-light conditions are focused on analyzing pixel characteristics induced by thermal effects from power consumption in peripheral circuits. These thermal effects create a contour in constructed images and manifest as a shading-like phenomena represented by difference in each pixel data. In this work, we present an additional source of shading in a constructed image. We have observed that band-gap reference circuit in CMOS Image sensors creates a local hot-spot and shading in an image. Experiments were performed to identify the relationship between the local hot-spot and the displacement of the band-gap reference circuit. We assumed that certain amount of photons are generated in an indirect bandgap silicon when forward biased and reach the nearby photo-diodes in active pixel array to induce the local hot-spot in an image. Our assumption on photon generation was confirmed through reducing the forward bias current in band-gap reference PN junction diodes and implementing a metal sidewall in-between the band-gap reference and active pixel array. By taking these measures, we were able to remove the local hot spot and its shading effect in CMOS Image Sensors. Moreover, as we carried out extensive experiments to pinpoint the cause of the local hot-spot, we have also noted that implementing a deep n-well or other implant blocking layers does not remove the shading effect. Keyword CIS, Photon, Image Shading, Band Gap Reference.

ESTRO 36 _______________________________________________________________________________________________ errors and to blindness relative to their potential degeneracies.The CI for M2 equals 88%, but 90% CI can be achieved for M2 by extending slightly the lateral PTV margin to encompass 92% of possible beam positions and 98% of possible ranges, leading to a 425% volume, thus still better than M3. ConclusionThe best tradeoff between robustness and optimality was achieved through random sampling of all errors limited by the lateral conventional PTV margin and a large margin for the possible proton ranges.

Objectives: Comparisons of induction chemotherapy (IC) against upfront chemoradiation (CRT) for locally advanced head and neck cancer (LA-HNSCC) have demonstrated no differences except greater toxicity with IC. Effective induction regimens that are less toxic are therefore warranted. To inform future efforts with IC, we present our institutional experience comparing a less toxic IC regimen to CRT. Methods: We included patients with LA-HNSCC treated with organ-preservation CRT (+/−induction) between 2008 and 2011. Patients were of age above 18 years, ECOG performance status 0-1, and had minimum 6 months follow-up. IC consisted of 8 weekly cycles of cetuximab, carboplatin, and paclitaxel followed by CRT. The CRT regimen was platinum based, with cetuximab reserved for patients contraindicated to receive platinum. Results: Of 118 patients, 24 (20%) received IC and 94 (80%) received CRT. Median follow-up was 17 (IC) and 19 (CRT) months ( P =0.05). There were no differences in toxicity between the groups. IC patients were more likely male, with more advanced tumor and nodal stage. Even when controlling for these factors, IC was still associated with worse locoregional control (HR=3.6, P =0.02), distant metastasis–free survival (HR=5.3, P =0.02), and overall survival (HR=5.1, P <0.01). Conclusions: IC patients had greater disease burden than those receiving CRT. IC was well tolerated, but with significant rates of locoregional and systemic failures. Given the retrospective nature of the study, our findings are not meant to be definitive or conclusive, but rather suggestive in directing future efforts with IC. For now, we favor CRT as the standard option for treatment of inoperable LA-HNSCC.

BackgroundWe report on a Phase 1 trial of photodynamic therapy (PDT) for superficial head and neck (H&N) lesions. Due to known oxygen dependencies of PDT, translational measurements of lesion hemoglobin oxygen saturation (StO2) and blood volume (tHb) were studied for associations with patient outcomes.MethodsPDT with aminolevulinc acid (ALA) and escalating light doses was evaluated for high-grade dysplasia, carcinoma-in-situ, and microinvasive carcinomas of the H&N. Among 29 evaluable patients, most (18) had lesions of the tongue or floor of mouth (FOM). Disease was intact in 18 patients and present at surgical margins in 11 patients. In 26 patients, lesion StO2 and tHb was measured.ResultsLocal control (LC) at 24 months was 57.5% among all patients. In patients with tongue/FOM lesions LC was 42.7%, and it was 50.1% for those with intact lesions. Lesion tHb was not associated with 3-month complete response (CR), but StO2 was higher in patients with CR. In tongue/FOM lesions, baseline StO2 [mean(SE)] was 54(4)% in patients (n=12) with CR versus 23(8)% in patients (n=6) with local recurrence/persistence (p=0.01). Similarly, for intact disease, baseline StO2 was 54(3)% in patients (n=10) with CR versus 28(8)% in patients (n=5) without CR (p=0.03). In patients with intact disease, higher baseline StO2 associated with 24-month local control (p=0.02).ConclusionsMeasurement of the physiologic properties of target lesions may allow for identification of patients with the highest probability of benefiting from PDT. This provides opportunity for optimizing light delivery based on lesion characteristics and/or informing ongoing clinical decision-making in patients who would most benefit from PDT.

Treatment for OPSCC can affect a number of outcomes related to quality of life (QOL). We explore differences in measures such as xerostomia, dysgeusia, weight loss, pain, and overall functional status in patients treated with either VMAT or PBS with and without cisplatin for OPSCC. We examined 95 consecutive patients from April 2013 to November 2014 who were treated with definitive radiation therapy (RT) or adjuvant RT following transoral robotic surgery (TORS). Individual ipsilateral and contralateral saliva-producing structures including parotid, submandibular, and sublingual glands, as well as buccal mucosa, tongue, hard palate, soft palate, and upper and lower lips were contoured. Patient-reported QOL questionnaires (n=229), including the European Organization for Research and Treatment of Cancer (EORTC)-QLQ30, EORTC-H&N35, Work Status, Dysgeusia, and GRiX xerostomia survey, were prospectively assessed at consult and during follow-up visits. Fifty-seven patients (60%) were treated with VMAT, and 38 patients (40%) were treated with PBS. Fifty-two patients (55%) were treated after TORS, and 43 (45%) with definitive RT or chemoradiation. Patients were followed for a median of 6 months. PBS conferred a significant 1.4- to 11.3-fold decrease in dose compared to VMAT for contralateral parotid and submandibular glands, bilateral sublingual glands, buccal mucosa, tongue, hard palate, soft palate, and lower and upper lip. Forty-four patients (18 PBS) had 6-month follow-up questionnaires. At 6 months, 65% of patients treated with VMAT had moderate-severe xerostomia compared to 39% for PBS (P=.08), with no difference in mild-severe sticky saliva (54% VMAT vs 61% PBS, P=.63) or mild-severe appetite changes (42% VMAT vs 33% PBS, P=.55). There was a trend toward improved taste in patients treated with PBS (56% PBS vs 31% VMAT, P=.1) at 6 months. In the subset of patients who received cisplatin (n=24), PBS was associated with significantly higher global health domain scores (PBS 92 vs VMAT 77, higher number is better, P=.04), less pain (PBS 2 vs VMAT 18, P=.007), and lower painkiller use (PBS 0 vs VMAT 40, P=.002). In our cohort of patients, PBS confers a significant dosimetric advantage to most saliva-producing oral cavity structures. We find a suggestion that this translates to a decrease in moderate-severe xerostomia as well as to taste changes for PBS compared to VMAT at 6 months. For patients receiving concurrent cisplatin, PBS is associated with an improved global health domain score, lower pain, and less painkiller use. To our knowledge this is the first study comparing VMAT and proton QOL outcomes in OPSCC patients. We are continuing to increase patient accrual and follow-up in this cohort. We aim to expand our current findings and report additional results in the near future.