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Delivery of craniospinal irradiation (CSI) is a curative approach to recurrent ependymoma, but is associated with risks from re-irradiation, particularly of the brainstem. Pencil beam scanning proton therapy allows delivery of CSI with sparing of normal tissues. Here, we describe a case of brainstem-sparing CSI that resulted in excellent coverage of the craniospinal axis with minimal radiation to brainstem. This is a novel concept that compares favorably to previously described methods using x-rays that may result in underdosing of surrounding tissues in effort to spare brainstem. Pediatr Blood Cancer 2015;62:718–720. © 2015 Wiley Periodicals, Inc.