Background: Conventional photon-based radiotherapy, such as with intensity-modulated radiation therapy and three-dimensional conformal radiation therapy, remains the standard treatment for oesophageal cancer where radiotherapy is required. However, they are associated with potential radiotoxicity to surrounding organs that confer significant morbidity and mortality. Proton beam therapy has emerged as a new technology with the potential to reduce organ at risk radiation through more precise tumour targeting. This updated systematic review and meta-analysis evaluates the efficacy and safety of proton beam therapy compared to conventional radiotherapy for oesophageal cancer. Methods: A comprehensive literature search was conducted across Medline, Embase and Cochrane Central databases. Articles which evaluated clinical outcomes and dosimetry data for proton beam therapy compared to conventional radiotherapy in patients with oesophageal cancer were included in this review. Results: Thirty-three studies, predominantly from the United States of America, were included. Pooled analysis demonstrates strong evidence to suggest proton beam therapy led to reduced grade 4 lymphopenia, reduced total pulmonary complications, improved odds in overall and progression free survival and reduced organ at risk radiation compared to conventional radiotherapy. These findings occur on the background of studies at low-moderate risk of bias but high clinical heterogeneity. Conclusion: There is preliminary evidence to suggest proton bream therapy reduces organ at risk radiation and radiotoxicity in oesophageal cancer. While these findings support the potential use of proton therapies, the limitations of the underlying evidence calls for further research to validate the long-term radiotoxicity and oncological outcomes before implementation of this therapy in policy and practice can occur.