A letter to the editor evaluates the effectiveness of photon-based intensity-modulated radiation therapy (IMRT) and proton therapy for the treatment of pediatric brainstem gliomas, focusing on the optimization of radiation dosimetry to prevent late toxic side effects. Three case studies are offered of IMRT or proton therapy for low-grade brainstem glioma, including brain magnetic resonance imaging (MRI) and computed tomography (CT), radiation dose, and hearing loss side effects.