The aim of the study is to analyse radiotherapy quality assurance (RTQA) processes in the treatment of paediatric central nervous system (CNS) tumours across Europe. The RTQA aspects of major past and current European trials for paediatric CNS tumours were reviewed based on study protocols and publications. A survey among radiation oncologists and paediatric oncologists about the practices of RTQA in paediatric CNS tumours across European countries was also performed. Several (inter)national initiatives to implement RTQA are being developed across Europe, with an apparent paradigm shift from retrospective to prospective RTQA. Experts from 21 of 29 contacted countries responded to the survey. National consensus guidelines for paediatric CNS tumours are available in 10 of 21 countries. Twenty-one of 33 experts believe that the level of involvement of paediatric radiation oncologists in the meetings and activities of the national paediatric oncology societies is adequate. Central storage of radiotherapy data is available in France, Germany and Denmark. RTQA programmes for paediatric brain tumours are available in 7 countries. Twelve of 21 experts believe that there is a well-established national referral network for the radiation treatment of paediatric patients in their respective countries. As a result of the review and survey, the following measures are proposed: (1) developing international RT guidelines for paediatric CNS tumours, (2) improving the collaboration between paediatric oncologists and paediatric radiation oncologists, (3) building a central storage system for RT data, (4) implementing international prospective RTQA platforms and (5) promoting European referral networks to reduce inequality.