A narrative review by the CNAO group on safety and efficacy of PT compared to photon RT for nasopharyngeal cancer (NPC) and oropharyngeal cancer (OPC). For NPC, PT reduced toxicities significantly compared to photon RT in terms of grade 3 mucositis, weight loss, dysphagia, rhinosinusitis, and in percutaneous endoscopic gastrostomy (PEG) tube placement and the rate of opioid pain medication requirement, however, PT caused a significantly increased rate of grade 3 radiation-induced dermatitis (RID) compared to VMAT (35% vs.7.5%, p < 0.00). For OPC, IMPT is associated with a significant reduction in PEG tube placement with respect to IMRT, however mandibular osteoradionecrosis (ORN) following PT is still a controversial issue as a study from the Memorial Sloan Kettering Cancer Center reported 13 out of 122 patients (10.6%) developed ORN at a median follow-up time of 40.6 months, and the 3-year and 5-year rates of ORN were 5.2% and 11.5%. Studies also demonstrated PT improved quality of life of patients for that symptom burden was significantly lower among the patients that underwent IMPT, in particular dysgeusia and decreased appetite during the subacute and chronic phases; IMPT patients were more able to keep on working towards higher productivity recovery levels. In this review, the authors also discussed the future development of PT in RBE and LET optimization and robustness, multi-Iin radiotherapy and proton minibeam, and the favorable biological properties and immunogenic effects of protons.