{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:08:40Z","timestamp":1790244520412,"version":"4.1.0"},"reference-count":189,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>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\u2010driven messaging on family decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While PBT offers clinical benefit in selecting pediatric cancers, high\u2010quality photon\u2010based 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\u2010based communication from providers and industry stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PROS advocates for an ethical, equitable, and evidence\u2010informed 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.32155","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:07:57Z","timestamp":1763626077000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"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"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-2034","authenticated-orcid":false,"given":"Natia","family":"Esiashvili","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-1873","authenticated-orcid":false,"given":"Daniel J.","family":"Indelicato","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7735-1111","authenticated-orcid":false,"given":"Jeannette","family":"Parkes","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0269-3045","authenticated-orcid":false,"given":"Arnold C.","family":"Paulino","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Beljoudi","sequence":"additional","affiliation":[{"name":"Department of Physics L\u00e9on B\u00e9rard Cancer Center  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Kristensen","sequence":"additional","affiliation":[{"name":"Department of Hematology Oncology and Radiation Physics Skane University Hospital  Lund Sweden"},{"name":"Department of Oncology Clinical Sciences Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Laprie","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Insitut Universitaire du Cancer de Toulouse Oncopole Claudius Regaud Universit\u00e9 De Toulouse  Toulouse 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