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Hypothesis: Proton therapy is the standard of care for pediatric patients, adolescents and young adults who require radiotherapy for many reasons.

Methods: Review the data on clinical benefits when using proton therapy in childhood cancer with regard to tumor control, risk for second primary cancer (SPC) and other late effects.

Results: Proton beam therapy (PBT) was used in clinical practice since the 1950’s. Early on, dose comparison studies demonstrated massive normal tissue sparing benefits. Clinical evidence demonstrated that dose escalation using PBT was feasible, safe and effective (i.e. in Chordomas, Chondrosarcomas), and the data was superior when compared to photon based external beam radiotherapy (XRT). Over the last few decades an increasing proportion of children with cancer, especially patients with CNS tumours or sarcomas, have been treated with PBT.

Clinical experience with acute and late effects, i.e. cytopenias, SPC, dysphagia, endocrine outcomes, quality of life and secondary tumors have demonstrated the superiority of PBT in comparison to XRT. As initially hypothed for medulloblastoma, these findings also support a huge cost effectiveness favouring PBT.  In accordance with these findings, the vast majority of trials for neuroblastomas, lymphomas and others, in addition to CNS tumors and sarcomas, embed PBT into the multimodality concept as a standard radiation modality in order to better protect immature tissues in children.

Conclusion: PBT offers not only dosimetric but also clinical benefits for children with cancer. PBT has been established in the majority of clinical trials in pediatric oncology already. As PBT becomes more available, the role and benefit of PBT will be confirmed.