Stage T or Ta, histologically-confirmed NPNSCC requiring orbital or skull base resection:\r\n* Stages T and Ta disease will be included regardless of nodal status (N or N-), provided that surgical therapy would require orbital or skull base resection\r\n* The surgical oncologist in each institution will determine the need for resection of the orbit OR base of skull at baseline for patients on both Arms A and B and following neo-adjuvant chemotherapy for patients on Arm B\r\n** Resection of skull base will be deemed necessary according to skull base bone erosion by CT or marrow involvement by MRI is noted; for any disease abutting the skull base\r\n** Resection of orbital contents will be deemed necessary according to skull base society guidelines, based on involvement of periorbital fat documented by MRI imaging
Patients must be deemed surgically resectable by the surgical teams at each institution and must have a determination of degree of anticipated structure preservation of orbit and skull base; this needs to be determined prior to randomization
Patients must not have received previous irradiation for head and neck tumor, skull base, or brain tumors
Previous radiotherapy to the scalp, cranium, brain, or skull base and radiation-induced meningiomas
Patients with residual enhancing tumor that lies completely within - cm of the inner table of the skull
A skull defect (such as, missing bone with no replacement)
Skull defect such as missing bone or bullet fragments.
Patient does NOT have known intracranial metastatic neuroblastoma; skull based disease with soft tissue extension is allowed
Previous irradiation for head and neck tumor, skull base, or brain tumors
The targeted tumor tissue is located in the cerebral hemispheres, > . cm from the inner table of the skull. Non-targeted parts of the tumor may extend outside the treated tumor limits.
Clips or other metallic implanted objects in the skull or the brain, except shunts.
Tumors arising in the skull and spine
Patients with major skull defects (such as missing bone without replacement) are not eligible
Targeted tumor is in the skull
The targeted tumor tissue is located in the cerebral hemispheres, > . cm from the inner table of the skull. Non-targeted parts of the tumor may extend outside the treated tumor limits.
Index tumor involves the skull
gross extension of tumor to the skull base;
Skull defect with missing bone
Patients with pathologically confirmed unresectable or borderline resectable squamous cell carcinoma of the larynx, hypopharynx, nasopharynx and oropharynx will be eligible for enrollment to the clinical trial; patients will be deemed unresectable if they have clinically confirmed carotid artery encasement, skull base involvement, trismus or deep neck musculature invasion at the time of diagnosis; borderline resectability will be defined as those patients in which surgery is unlikely to result in excision of all macroscopic disease or will result in a total base of tongue glossectomy, total laryngopharyngectomy, skull base resection or carotid resection
Skull defect (e.g. missing bone with no replacement)
Index tumor involves the skull (treatment of other painful tumors in subjects with skull tumors is not excluded)
Skull defect without replacement
Targeted (treated) tumor is in the skull
Skull defects such as missing bone flap, a shunt, or bullet fragments.
Patients must be indicated for major head and neck surgery, defined as surgeries with an anticipated post-surgical hospital stay of  or more days; examples of major surgeries include, but are not limited to, total laryngectomy, large oral cavity, oropharyngeal, salivary gland, or soft tissue resections requiring free flap or major regional flap (e.g. pectoralis major flap), and large skull base procedures requiring extensive skull base reconstruction
Patients receiving brain RT for intracranial disease (including recurrent head and neck tumors with base of skull or intracranial extension) or for prophylactic cranial irradiation, over - weeks period of time
Skull or bony defect in the area contacting the immobilization straps
Painful metastases to the skull, hands, feet are not eligible treatment sites, but can be treated off study with conventional fractionation at the discretion of the treating physician
Index tumor involves the skull (treatment of other painful tumors in subjects with skull tumors is not excluded)
Diagnosis of histologically proven node-positive lung cancer (n=) OR base of skull or brain tumor (n=)
Adult subjects with brain, head and neck, and skull base tumors receiving external beam proton radiotherapy on gantry at the Francis H. Burr Proton Therapy Center at Massachusetts General Hospital (MGH)
For those enrolled in Adjuvant Treatment with Optune, patients are excluded if they are <  years of age, have an active implanted medical device, a skull defect, bullet fragments in the head, sensitivity to conductive hydrogels, a scalp condition that might interfere with wearing the device, or GBM that is not supratentorial.