BACKGROUND AND PURPOSE: Brain tumours are the most frequent solid tumours in 
children and the most frequent radiotherapy indications in paediatrics, with 
frequent late effects: cognitive, osseous, visual, auditory and hormonal. A 
better protection of healthy tissues by improved beam ballistics, with particle 
therapy, is expected to decrease significantly late effects without decreasing 
local control and survival. This article reviews the scientific literature to 
advocate indications of protontherapy and carbon ion therapy for childhood 
central nervous system cancer, and estimate the expected therapeutic benefits.
MATERIALS AND METHODS: A systematic review was performed on paediatric brain 
tumour treatments using Medline (from 1966 to March of 2014). To be included, 
clinical trials had to meet the following criteria: age of patients 18 years or 
younger, treated with radiation, and report of survival. Studies were also 
selected according to the evidence level. A secondary search of cited references 
found other studies about cognitive functions, quality of life, the comparison 
of photon and proton dosimetry showing potential dose escalation and/or sparing 
of organs at risk with protontherapy; and studies on dosimetric and technical 
issues related to protontherapy.
RESULTS: A total of 7051 primary references published were retrieved, among 
which 40 clinical studies and 60 papers about quality of life, dose distribution 
and dosimetry were analysed, as well as the ongoing clinical trials. These 
papers have been summarized and reported in a specific document made available 
to the participants of a final 1-day workshop. Tumours of the meningeal envelop 
and bony cranial structures were excluded from the analysis. Protontherapy 
allows outstanding ballistics to target the tumour area, while substantially 
decreasing radiation dose to the normal tissues. There are many indications of 
protontherapy for paediatric brain tumours in curative intent, either for 
localized treatment of ependymomas, germ-cell tumours, craniopharyngiomas, 
low-grade gliomas; or panventricular irradiation of pure non-secreting 
germinoma; or craniospinal irradiation of medulloblastomas and metastatic pure 
germinomas. Carbon ion therapy is just emerging and may be studied for highly 
aggressive and radioresistant tumours, as an initial treatment for diffuse 
brainstem gliomas, and for relapse of high-grade gliomas.
CONCLUSION: Both protontherapy and carbon ion therapy are promising for 
paediatric brain tumours. The benefit of decreasing late effects without 
altering survival has been described for most paediatric brain tumours with 
protontherapy and is currently assessed in ongoing clinical trials with 
up-to-date proton devices. Unfortunately, in 2015, only a minority of paediatric 
patients in France can receive protontherapy due to the lack of equipment.