386 children with nonmetastatic grade II/III intracranial ependymoma received proton therapy. With the median follow-up of 5 years, the 7-year local control, progression-free survival and overall survival rates were 77.0%, 63.8% and 82.2%. The cumulative incidence of grade 2+ brainstem toxicity was 4%. The second-malignancy rate was 0.8%. The authors concluded that proton therapy offers commensurate disease control to modern photon therapy without unexpected toxicity. The high rate of long-term survival justifies efforts to reduce radiation exposure in this young population.