"When you learn your child has brain cancer or another aggressive tumor youre intensely focused on the immediate present. Which course of treatment  what combination of surgery chemotherapy or radiation httpshealth.usnews.comhealthnewspatientadvicearticlesradiationevolvingchoicesincancertreatment  will best help your child survive But with most kids living long past httpshealth.usnews.comhealthnewspatientadvicearticlescancersurvivortakingonnewmeaningforpatients their cancer diagnosis its also important to consider how treatments they undergo now may affect them later httpshealth.usnews.comhealthnewsbestchildrenshospitalsarticlesisurvivedchildhoodcancernowwhat even as adults.  One choice some parents may face is whether to seek a newer type of radiation called proton beam therapy instead of conventional Xray radiation to potentially reduce harmful side effects in their developing child. Proton beam therapy is considered a big advance in cancer therapy by some experts. Others however hesitate to get caught up in the early hype without more longterm evidence. Even so people are traveling far and wide so their children can receive proton therapy from the handful of centers where its offered. Four leading radiation oncologists httpshealth.usnews.comdoctorslocationindexradiationoncologists explained to U.S. News what parents should understand about proton therapy and its possible benefits See  Concerns Parents Have About Their Kids Health httpshealth.usnews.comhealthnewspatientadviceslideshowsinnovationsincancertherapy. Proton beam therapy is a form of radiation that may reduce late side effects compared with conventional Xray radiation. The pinpoint beam and lack of exit dose  which is unneeded radiation as the conventional Xray beam passes beyond the tumor and through the body on its way out the other side  spares healthy normal tissue in developing areas such as the brain heart and lungs. Childhood brain cancer is considered one of the most evidencebased uses for proton therapy. It may prevent late effects such as hearing loss or reduced ability to do well in school. However at least for now proton therapy does not offer a higher possibility of cure than traditional Xray radiation.  The brain is the most common area for kids to develop cancerous tumors that require radiation treatment says Dr. Torunn Yock director of pediatric radiation oncology at Massachusetts General Hospital httpshealth.usnews.combesthospitalsareamamassachusettsgeneralhospital and an associate professor at Harvard Medical School.  Because the pediatric brain is still growing and developing if you irradiate the brain during this process it wont continue to grow and develop as it normally would she says. And this over time leads to slowing of development which shows up as drops in neurocognitive testing. The younger the child the more potential exists for stunted development Yock says. A yearold is very different from a yearold in terms of brain development so the adverse consequences are much greater in the yearold.  Clearly theres an advantage to not irradiating healthy brain tissue she says. For instance avoiding the brains vision and auditory centers may save children from loss or impairment of sight or hearing.   See  Innovations in Cancer Therapy httpshealth.usnews.comhealthnewspatientadviceslideshowsinnovationsincancertherapy. Proton beam therapy allows doctors to give the same dose as with traditional radiation while reducing the dose  and complications  to normal healthy tissue says Dr. Sameer Keole medical director of the proton beam therapy program at Mayo Clinic in Arizona httpshealth.usnews.combesthospitalsareaazmayoclinic. It also allows the use of a higher dose than traditional Xray radiation also called photon radiation to treat resistant tumors while still protecting surrounding tissue.  With traditional radiation to the brain the radiation scatters. That collateral radiation exposes large amounts of brain to low doses of radiation says Dr. Thomas Merchant chair of radiation oncology at St. Jude Childrens Research Hospital httpshealth.usnews.combesthospitalsareatnstjudechildrensresearchhospital in Memphis Tennessee. Even lower doses of radiation can be harmful he adds.  In November  the new St. Jude Red Frog Events Proton Therapy Center  the worlds only protontherapy center dedicated solely to the treatment of children  began treating kids with aggressive cancers including brain tumors and Hodgkin lymphoma.  There are certain brain tumors in children where we have to treat the entire brain and spine Merchant says. If we give proton therapy we dont have exit radiation into the chest and abdomen that you have when you treat someone with conventional radiation. That may reduce longterm side effects in the heart and lungs. With the newest form of proton therapy called pencilbeam scanning  which conforms or shapes the highestdose radiation to the targeted tumor  its possible to reduce the margin area around the tumor exposed to radiation Merchant says. That method which is used by St. Jude may eventually have the potential to reduce the risk of secondary cancers.  See  Essential Items to Pack in Your Childs Hospital Bag httpshealth.usnews.comhealthnewspatientadviceslideshowsessentialitemstopackinyourchildshospitalbag. Dr. Anita Mahajan a professor and chief of pediatric radiation oncology at the University of Texas MD Anderson Cancer Center httpshealth.usnews.combesthospitalsareatxuniversityoftexasmdandersoncancercenterrankings says when she describes proton therapy to parents she emphasizes that proton therapy is radiation.  The biggest difference she explains is that the subatomic particle the proton stops where the oncologists need it to. It has to get in but we can stop it from coming out. That ability to avoid other organs is important. For instance if were treating a young child for pelvic rhabdomyosarcoma a muscle and connective tissue cancer one of the things we might be able to do is avoid the growth plates in the femurs Mahajan says. That might give you less problem with growth asymmetry of the legs as they get older. Future fertility is a factor httpshealth.usnews.comhealthnewspatientadvicearticlespreparingforababyaftercancer in cancer treatment planning. In cases involving radiation around the pelvic area its sometimes possible to avoid the ovaries in a young girl or the testes in a boy.  Spaceship Hamster Wheel A proton is a positively charged atomic particle. In proton therapy a powerful machine called a particle accelerator speeds protons up to reach a high energy level. The technology is massive  three stories high and weighting upward of  tons  requiring special housing within a treatment facility to contain the equipment and deliver the proton beams. A rotating device called a gantry releases protons to the tumor from different angles. You can take a quick virtual tour httpnationalpress.orgtopicvirtualtourofprotonbeamcancertreatmentsttmmVideo of proton beam therapy at the Mayo Clinic in Arizona. In the treatment room patients are positioned on a table or in a specialized chair. CT or MRI scans are taken before each treatment to ensure accurate positioning. Some children need sedation to sleep through the treatment while others who can remain still may stay awake.  Patients may need immobilization devices to keep them in the proper precise position for every protonbeam treatment. With brain cancer patients usually wear a customfitted mask to maintain their position.  Parents can accompany children to the treatment room and see them settle in before treatment begins Mahajan says. A child life specialist httpshealth.usnews.comhealthnewshealthwellnessarticlesfactsaboutchildlifespecialists is part of the team to help children and families cope with the entire patient experience. While the treatment itself is painless side effects can include skin problems like swelling dryness blistering or peeling  similar to traditional radiation. Fatigue nausea and vomiting are side effects as well and are also due to other treatments patients receive like chemotherapy.  Meg McQuillan of Riverside Connecticut recalls her sons introduction to proton beam therapy three years ago when he was treated at Mass General for a type of brain tumor called medulloblastoma. He and fellow patients named the device the spaceship hamster wheel. Young people take the treatment process in stride Keole says. Kids are tough he says. Sometimes theyre a lot tougher than adults. By and large they have a great attitude.  Cost and Access There are  operating proton beam centers in the U.S. http according to the National Association for Proton Therapy unevenly distributed throughout the country. Only a portion exist in the context of a pediatricfocused cancer program. Between  and  pediatric patients get proton radiation therapy each year according to Yocks rough estimate.  With a typical treatment course lasting six weeks families face the disruption of traveling to a childrens hospital httpshealth.usnews.combesthospitalspediatricrankingscancer with a proton therapy center finding lodging and making arrangements for other children at home. Proton therapy costs roughly twice as much as traditional Xray radiation. The average cost for a full course of proton radiation treatment is estimated at . Creating a new proton center is a huge investment. If you look at simply the upfront costs it will be three to four times more expensive than photons Yock says. It is absolutely intensive in terms of people and equipment needed and the quality assurance and the engineers and the physicists. Its a huge team thats required to run it safely with good quality control. Yock coauthored a study published in December  in the journal Cancer which compared the costeffectiveness of proton radiation therapy versus traditional radiation among kids with medulloblastoma. The study which used models to measure longterm side effects and related costs in treatment workforce participation and quality of life found that proton therapy was costeffective. As Mahajan says If we can prevent some neurocognitive deficits endocrine issues growth issues skeletal deformities those are going to help that child be more productive in society and need fewer medical interventions down the road.  Insurance usually covers the cost of proton therapy when a cancer is considered curable Yock says Ninetyeight percent of the time we are successful with arguing to get a pediatric patient treatment she says.  We dont take the recommendation to give radiation lightly Merchant says. Patients are carefully evaluated to determine the course of treatment. Its so important for the parents as well as the child to know what theyre getting into he adds. One thing we do is compare treatment plans using proton or conventional or photon radiation and choose the best plan. And in most cases the proton plan looks better."