Abstract
<title>Abstract</title> <p>Purpose Benign brain tumors have favourable survival, making long-term patient-reported outcomes (PROs) after radiotherapy clinically important. Proton beam therapy (PBT) can reduce dose to healthy brain tissue, but long-term survivorship PROs remain limited. The aim of this study was to evaluate health-related quality of life (HRQoL) and brain tumor–specific symptoms over five years after PBT for patients with benign brain tumors. Methods In this prospective cohort study, adults treated with PBT completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BN20 questionnaires from baseline through 5 years. Mixed models for repeated measures estimated mean scores and change from baseline with 95% confidence intervals. Exploratory analyses evaluated associations between sociodemographic factors and the change from baseline to five years. Results Seventy-seven of 126 participants (61%) completed the 5-year follow-up. Global health status did not change significantly at 5 years. Clinically meaningful worsening was observed for fatigue and insomnia, with small-to-moderate increases in pain, dyspnoea, and constipation. Physical and cognitive functioning declined modestly, while emotional functioning improved. On the QLQ-BN20, hair loss increased to a clinically meaningful extent and drowsiness, bladder control difficulties, motor dysfunction, communication deficits, and leg weakness worsened over time, whereas headaches decreased. Older age and retired/unemployed status were associated with greater deterioration in role and social functioning, older age was associated with worsening bladder control. Conclusions HRQoL was largely preserved five years after PBT for benign brain tumors. However, persistent symptoms and modest functional declines support structured long-term follow-up and targeted survivorship care.</p>