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Selection of the Most Appropriate Radiation Treatment Modality for Children's Cancers : A Paediatric Radiation Oncology Society (PROS) Position Paper on the Ethical Utilization of Proton Therapy

Esiashvili, Natia ; Indelicato, Daniel J. ; Mahajan, Anita ; Parkes, Jeannette ; Paulino, Arnold C. ; Beljoudi, Guillaume ; Kristensen, Ingrid LU ; Laprie, Anne ; Lassen, Yasmin and Njiraini, Pauline Njoki , et al. (2026) In Pediatric Blood and Cancer 73(2).
Abstract

Background: Proton beam therapy (PBT) offers dosimetric advantages in pediatric radiotherapy by reducing radiation exposure to healthy tissues. However, broad implementation raises important ethical, logistical, and equity considerations, especially in settings with limited access to advanced technologies. Procedure: This position paper by the Paediatric Radiation Oncology Society (PROS) reviews the clinical rationale for selecting radiotherapy modalities in children, with a specific focus on ethical utilization of PBT. The document synthesizes evidence on the benefits and limitations of modern photon and proton therapies, explores disparities in access, outlines the role of local pediatric radiation oncologists, and addresses the... (More)

Background: Proton beam therapy (PBT) offers dosimetric advantages in pediatric radiotherapy by reducing radiation exposure to healthy tissues. However, broad implementation raises important ethical, logistical, and equity considerations, especially in settings with limited access to advanced technologies. Procedure: This position paper by the Paediatric Radiation Oncology Society (PROS) reviews the clinical rationale for selecting radiotherapy modalities in children, with a specific focus on ethical utilization of PBT. The document synthesizes evidence on the benefits and limitations of modern photon and proton therapies, explores disparities in access, outlines the role of local pediatric radiation oncologists, and addresses the impact of industry-driven messaging on family decision-making. Results: While PBT offers clinical benefit in selecting pediatric cancers, high-quality photon-based treatments such as IMRT and VMAT remain effective and widely accessible alternatives. The referral and evaluation process for PBT is complex and may introduce treatment delays. Travel and financial burdens can exacerbate disparities. PROS underscores the critical role of local pediatric radiation oncologists in counseling families, and calls for balanced, evidence-based communication from providers and industry stakeholders. Conclusions: PROS advocates for an ethical, equitable, and evidence-informed approach to radiotherapy modality selection in children, reflecting holistic considerations beyond dosimetry. Proton therapy should be pursued when clinically indicated and accessible without compromising timely care. Investment in a comprehensive radiation therapy infrastructure, including professional education, collaborative research, and responsible public messaging, is essential to optimize pediatric cancer outcomes globally.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
access to care, financial toxicity, health equity, pediatric radiation oncology, proton therapy, radiotherapy ethics
in
Pediatric Blood and Cancer
volume
73
issue
2
article number
e32155
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:41261937
  • scopus:105022517521
ISSN
1545-5009
DOI
10.1002/pbc.32155
language
English
LU publication?
yes
id
2d21b30e-7005-4335-80a2-b4d74e22d68e
date added to LUP
2026-02-09 14:55:38
date last changed
2026-02-09 14:56:47
@article{2d21b30e-7005-4335-80a2-b4d74e22d68e,
  abstract     = {{<p>Background: Proton beam therapy (PBT) offers dosimetric advantages in pediatric radiotherapy by reducing radiation exposure to healthy tissues. However, broad implementation raises important ethical, logistical, and equity considerations, especially in settings with limited access to advanced technologies. Procedure: This position paper by the Paediatric Radiation Oncology Society (PROS) reviews the clinical rationale for selecting radiotherapy modalities in children, with a specific focus on ethical utilization of PBT. The document synthesizes evidence on the benefits and limitations of modern photon and proton therapies, explores disparities in access, outlines the role of local pediatric radiation oncologists, and addresses the impact of industry-driven messaging on family decision-making. Results: While PBT offers clinical benefit in selecting pediatric cancers, high-quality photon-based treatments such as IMRT and VMAT remain effective and widely accessible alternatives. The referral and evaluation process for PBT is complex and may introduce treatment delays. Travel and financial burdens can exacerbate disparities. PROS underscores the critical role of local pediatric radiation oncologists in counseling families, and calls for balanced, evidence-based communication from providers and industry stakeholders. Conclusions: PROS advocates for an ethical, equitable, and evidence-informed approach to radiotherapy modality selection in children, reflecting holistic considerations beyond dosimetry. Proton therapy should be pursued when clinically indicated and accessible without compromising timely care. Investment in a comprehensive radiation therapy infrastructure, including professional education, collaborative research, and responsible public messaging, is essential to optimize pediatric cancer outcomes globally.</p>}},
  author       = {{Esiashvili, Natia and Indelicato, Daniel J. and Mahajan, Anita and Parkes, Jeannette and Paulino, Arnold C. and Beljoudi, Guillaume and Kristensen, Ingrid and Laprie, Anne and Lassen, Yasmin and Njiraini, Pauline Njoki and Qureshi, Bilal Mazhar and Robles, Beatriz Garcia and Seiersen, Klaus and Timmermann, Beate and Gaze, Mark N.}},
  issn         = {{1545-5009}},
  keywords     = {{access to care; financial toxicity; health equity; pediatric radiation oncology; proton therapy; radiotherapy ethics}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Pediatric Blood and Cancer}},
  title        = {{Selection of the Most Appropriate Radiation Treatment Modality for Children's Cancers : A Paediatric Radiation Oncology Society (PROS) Position Paper on the Ethical Utilization of Proton Therapy}},
  url          = {{http://dx.doi.org/10.1002/pbc.32155}},
  doi          = {{10.1002/pbc.32155}},
  volume       = {{73}},
  year         = {{2026}},
}