Radiotherapy is effective in increasing local control in pediatric tumors, but it is often associated with severe late effects, including secondary malignancy and neuro-cognitive impairment. The physical advantages of protons, compared with conventional photons, decrease radiation dose to healthy tissues and allow dose escalation, and has translated into significant clinical benefits in multiple clinical studies. This better toxicity profile could substantially have positive impact on the survivors' quality of life. Proton radiation has been used safely and effectively for medulloblastoma, craniopharyngioma, ependymoma, germ cell intracranial tumors, low-grade glioma, retinoblastoma, chordoma, soft tissue sarcomas, lymphoma and neuroblastoma. Patients might not be able to obtain the benefits of protons because of the shortage of proton facilities. The spread of more proton centers in the near future will make this technology easily accessible to pediatric patients. Specialized teams of radiation oncologists, medical physicists, radiation therapists, anesthesiologists and nurses are needed. New protocols should be designed to investigate the benefits on late toxicity and quality of life. This presentation will give an overview of the state of the art proton therapy in the treatment of pediatric malignancies.
