Although proton treatment plans often showed advantages over photon plans in reducing dose to OARs, the clinical implications were yet to be proven. The key issues remain in range uncertainty and motion management when applying protons for pancreatic cancer. While studies have shown proton therapy is safe and tolerable, non-randomized comparative data have not consistently shown a statistical difference between proton and photon irradiation in terms of oncologic outcomes or toxicity to date, and randomized data so far are lacking.