. This analysis included 33 primary studies that reported outcomes of pediatric patients with brain cancer treated with either proton or photon radiotherapy. This analysis reported no statistically significant difference between the XRT and PT group for 5-year overall survival (p = 0.224). With a total of 937 patients analyzed for hypothyroidism, this analysis reported the odds of developing hypothyroidism were almost five times higher with XRT than with PT (p = 0.002). In neurocognitive domains, patients receiving PT performed better in terms of working memory (p = 0.155), processing speed (p = 0.042), and perceptual reasoning (p = 0.055). For other toxicities, a reduction in nausea was observed in patients receiving PT (p = 0.028) versus XRT, and there was no significant differences in ototoxicity, ophthalmologic disorders and neurological side effects between the two modalities. The authors concluded that PT can be beneficial in reducing postradiotherapy toxicity for children with brain tumors.