Should all pediatric CNS cases be referred to a proton center?

I hope there will be a substantial amount of debate on this question, and so I have invited several pediatric radiation oncologists treating patients at institutions where protons are and are not utilized.

The weight of the building data on this topic in the literature is mounting such that more and...

Thank you for your very insightful comments, @Dr. First Last I agree with you on all points. Will just add that for children with CNS tumors that have poor prognosis [e.g. DIPG, or diffuse pediatric-type HGG H3-wt IDH-wt (classified as glioblastoma in earlier WHO CNS classifications)], clinical adva...

I wouldn’t say all but quite a few. Denial is not just a river in Egypt. Obtain comparative dosimetry and, if protons are better, use them. That said, some who don’t have protons tend to devalue them. [Do what you would do for your child (or grandchild)]!

This is a terrific question and Dr. @Dr. First Last has provided an excellent and thoughtful answer. It is interesting to look back at the progressive adoption of protons in the COG CNS protocols (I believe first allowed in 2000 for infant medulloblastoma, then 2003 for ependymoma, 2004 for all medu...