This study compared acute toxicities and reconstructive complications in patients treated with proton-based (n = 11)and photon-based PMRT (n = 26). Grade 2 skin toxicity was the most common acute toxicity in both groups (55% and 73% in the proton and photon group, respectively) (p = 0.077). Three patients (27%) in the proton group developed grade 3 skin toxicity. No Grade 4 acute toxicity was reported in either group. Reconstructive complications occurred in 4 patients (36%) in the proton group and 8 patients (31%) in photon group (p = 0.946). The authors concluded that reconstructive complications were not significantly higher in patients treated with proton- versus photon-based PMRT in this cohort.