What is Proton Therapy
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Childhood Cancers

Dr. Ralph Ermoian discusses the importance of proton therapy in treating childhood cancers. Proton therapy is more precise and can be better controlled than conventional radiation therapy delivered with X-rays and can reduce the likelihood of short- and long-term side effects in children.

“The day that they told us he was cancer free, I was crying. And the next day, when he was getting his chemo port taken out, he looked up and said to me, ‘Yesterday, those were tears of joy, right mom?’ And I said, ‘Yes.’” - Parent of Childhood Cancer Survivor


The advantages of proton therapy treatments over standard X-ray radiation

A number of complications can result with the use of X-ray radiation therapy for pediatric brain cancer. Because the hypothalamus is close to the site of radiation, the neurohormones produced in that organ can be affected. These neurohormones stimulate the secretion of growth and thyroid hormones, which are particularly important in a growing child.

Research has shown that proton therapy may significantly reduce the likelihood and/or amount of developmental abnormalities, growth delays, reductions in IQ, and other complications that often occur with standard X-ray radiation.

Protons are preferred in many pediatric cancers, including:

  • Anaplastic astrocytoma 
  • Atypical teratoid/Rhabdoid tumor
  • Chordoma
  • Craniopharyngioma 
  • Desmoid tumor 
  • Ependymoma 
  • Ewing’s Sarcoma 
  • Gliomas, including optic pathway/hypothalamic glioma, oligodendroglioma, oligoastrocytoma
  • Glioblastoma
  • Intracranial germ cell tumors (germinoma)
  • Juvenile angiofibromas 
  • Lymphoma 
  • Medulloblastoma 
  • Meningioma
  • Nasopharyngeal carcinoma 
  • Neuroblastoma 
  • Osteosarcoma 
  • Pineoblastoma 
  • Retinoblastoma 
  • Rhabdomyosarcoma 

Proton therapy is generally preferred for treating solid tumors in children because it delivers less radiation to healthy tissue, which helps prevent serious complications and causes fewer short- and long-term side effects. The following diagram shows the difference in radiation dose between protons and the most sophisticated form of X-ray radiation in treating a common pediatric cancer, medulloblastoma. Proton therapy delivers less radiation to the heart, lungs and abdomen for pediatric patients with medulloblastoma. Less radiation to these critical organs reduces the likelihood that patients will experience adverse effects years after treatment.

Studies show that using proton therapy to control pediatric tumors provides excellent results while reducing damage to healthy tissue and reducing the likelihood of cancers occurring at other sites in the body.

Orbital rhabdomyosarcoma (RMS) is a type of tumor that occurs in the socket (or orbit) that houses the eye. This cancer is curable 85% of the time. While the studies on treating this cancer with proton therapy are small in size, the results show great promise. In a study done at Massachusetts General Hospital, proton therapy delivered less radiation to normal tissue than X-rays, and, six years later, patients experienced fewer side effects.

Treatment Options at a Glance

Proton therapy

The use of proton radiation to kill cancer cells by preventing them from dividing and growing.

Standard X-ray radiation

The use of photon radiation to kill cancer cells by preventing them from dividing and growing.


Surgical removal of tumor and affected cells.


The use of drugs to kill or alter the cancer cells.

The treatment for your child will depend on the specific type of cancer he or she has. When treating pediatric cancers, a combination of treatments is often used. The good news is that advances in treatment methods and technology have significantly improved outcomes. Over 80% of childhood cancers are now curable.

Checklist to Get Started

Here is a checklist of items you will need for your initial call with us:

You provide:

  • Demographic information for patient and parents
  • (legal name, etc.)
  • Insurance information
  • Related doctor and facility information

Ask your specialist(s) to provide:

  • Pathology reports
  • Clinical notes
  • Imaging
  • Imaging Reports
  • Records regarding significant past medical history or surgeries
  • Anesthesia reports

Additional Resources:

Childhood Cancer Survivor Story

Speak with a Parent

Childhood Cancers

“I want to provide the same care that I would want and expect of my own health-care providers if I had cancer: compassionate, detail-oriented, and patient-centered care that is tailored to the patient’s medical needs and goals.”

Sarcomas; Childhood Cancers, Base of Skull and Spine Tumors

"It is my privilege to work with you and your support system to find the perfect path that aligns with your values, goals, and challenges - taking into consideration the concerns of today, but also accounting for the worries of tomorrow, next year, and the decades beyond."

Childhood Cancers

"A cancer diagnosis, especially in a child, doesn’t solely affect the child, it affects the entire family. I strive to support each patient and family, as I would my own, to prepare them for both the current details of treatment as well as providing anticipatory guidance for the future."

Related Studies

Second nonocular tumors among survivors of retinoblastoma treated with contemporary photon and proton radiotherapy Sethi RV, Shih HA, Yeap BY, Mouw KW, Petersen R, Kim DY, Munzenrider JE, Grabowski E, Rodriguez-Galindo C, Yock TI, Tarbell NJ, Marcus KJ, Mukai S, Macdonald SM. Read Study
Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study Yock TI, Yeap BY, Ebb DH, Weyman E, Eaton BR, Sherry NA, Jones RM, MacDonald SM, Pulsifer MB, Lavally B, Abrams AN, Huang MS, Marcus KJ, Tarbell NJ Read Study
Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015 Turcotte LM1, Liu Q2, Yasui Y3, Arnold MA4, Hammond S4, Howell RM5, Smith SA5, Weathers RE5, Henderson TO6, Gibson TM7, Leisenring W8, Armstrong GT7, Robison LL7, Neglia JP1. Read Study
Proton versus photon radiotherapy for common pediatric brain tumors: comparison of models of dose characteristics and their relationship to cognitive function Merchant TE, Hua CH, Shukla H, Ying X, Nill S, Oelfke U. Read Study
Proton radiotherapy for pediatric central nervous system ependymoma: clinical outcomes for 70 patients. Shannon M. MacDonald, Roshan Sethi, Beverly Lavally, Beow Y. Yeap, Karen J. Marcus, Paul Caruso, Margaret Pulsifer, Mary Huang, David Ebb, Nancy J. Tarbell, and Torunn I. Yock Read Study
Involved-node proton therapy in combined modality therapy for Hodgkin lymphoma: results of a phase 2 study Hoppe BS, Flampouri S, Zaiden R, Slayton W, Sandler E, Ozdemir S, Dang NH, Lynch JW, Li Z, Morris CG, Mendenhall NP. Read Study
Clinical Outcomes and Late Endocrine, Neurocognitive, and Visual Profiles of Proton Radiation for Pediatric Low-Grade Gliomas Benjamin A. Greenberger, AB, Margaret B. Pulsifer, PhD, David H. Ebb, MD, Shannon M. MacDonald, MD, Robin M. Jones, MD, William E. Butler, MD, Mary S. Huang, MD, Karen J. Marcus, MD Read Study
Cost effectiveness of proton therapy compared with photon therapy in the management of pediatric medulloblastoma. Mailhot Vega RB1, Kim J, Bussière M, Hattangadi J, Hollander A, Michalski J, Tarbell NJ, Yock T, MacDonald SM. Read Study
Breast cancer screening for childhood cancer survivors after craniospinal irradiation with protons versus x-rays: a dosimetric analysis and review of the literature. Kumar RJ, Zhai H, Both S, Tochner Z, Lustig R, Hill-Kayser C. Read Study
The predicted relative risk of premature ovarian failure for three radiotherapy modalities in a girl receiving craniospinal irradiation Pérez-Andújar A, Newhauser WD, Taddei PJ, Mahajan A, Howell RM. Read Study
Predicted risks of radiogenic cardiac toxicity in two pediatric patients undergoing photon or proton radiotherapy Zhang R, Howell RM, Homann K, Giebeler A, Taddei PJ, Mahajan A, Newhauser WD. Read Study
Early clinical outcomes using proton radiation for children with central nervous system atypical teratoid rhabdoid tumors. De Amorim Bernstein K, Sethi R, Trofimov A, Zeng C, Fullerton B, Yeap BY, Ebb D, Tarbell NJ, Yock TI, MacDonald SM. Read Study
Proton radiotherapy for pediatric central nervous system germ cell tumors: early clinical outcomes MacDonald SM, Trofimov A, Safai S, Adams J, Fullerton B, Ebb D, Tarbell NJ, Yock TI. Read Study