INTRODUCTION: Childhood craniopharyngioma is a complex condition to manage. 
Survival figures are high but the potential for long-term morbidity is great. 
There is much debate regarding the best management for these tumours with 
increasing interest in the use of proton beam therapy. We have therefore 
reviewed our radiotherapy (RT) practice at Westmead Hospital and the literature 
regarding the use of protons for these children.
METHODS: Three children have received fractionated stereotactic RT for 
craniopharyngioma at Westmead Hospital since 2007. Each RT plan was reviewed and 
additional organs at risk were contoured to enable comparison with published 
proton data.
RESULTS: Planning target volume coverage was similar with all modalities: with 
the conformity index ranging from 0.70 to 0.78 in our patients compared with 
0.50-0.84 in the published data. RT dose to temporal lobes, hippocampi and whole 
brain was also similar with protons and photons. Proton beam therapy may give 
lower dose to the Circle of Willis than stereotactic RT.
CONCLUSION: Currently there is no clear evidence that proton beam therapy will 
improve survival or reduce morbidity for children with craniopharyngioma. 
However, proton therapy has the potential to reduce RT dose to the Circle of 
Willis, which may reduce the risk of future cerebrovascular complications. We 
propose that more resources should be allocated to ensuring these patients are 
managed by experienced multidisciplinary teams through the continuum from 
diagnosis to long-term follow-up.