How, if at all, does your approach to adjuvant chemoradiation differ with proton beam radiation vs. conventional photon radiation for H&N Cancers?

As there is no prospective data for protons over photons in head and neck cancer, despite the proliferation in utilization, I would not feel comfortable treating this way unless it was the only option.

In addition, recent reports indicate a relatively high risk of mandibular ORN, which is hardly seen...

It doesn’t.

Nothing changes in regard to the treatment approach. Planning is of course different. Adjuvant radiation and adjuvant chemotherapy indications remain the same. Studies are ongoing regarding the potential benefits/harms of proton therapy for H&N cancer, which are eagerly awaited.