Radiotherapy and Pregnancy Addressing Reproductive Health and Fertility Preservation in Cancer Patients

A BSTRACT Cancer treatment in reproductive-aged patients poses increasing clinical challenges due to the rising incidence of cancer in adolescents and young adults and the global trend toward delayed childbearing. Radiotherapy remains a key modality for achieving disease control or cure but carries the risk of compromising fertility through direct gonadal damage or disruption of hormonal function. Two clinical scenarios require particular attention: cancer diagnosed during pregnancy and the need to preserve fertility before starting treatment. Pelvic irradiation is generally avoided during pregnancy because of the risk of fetal radiation exposure, although radiotherapy to nonpelvic sites may be considered in selected cases with appropriate precautions. Fertility preservation techniques such as oocyte, sperm, embryo, and gonadal tissue cryopreservation have expanded reproductive options for patients undergoing cancer treatment. Clinical studies have demonstrated that these approaches can be safely implemented without negatively affecting oncological outcomes. Despite these advances, many patients receive limited or no counseling regarding fertility risks before treatment. Multidisciplinary management, including early referral to reproductive specialists, is essential to support informed decision-making. This narrative review outlines current knowledge, clinical considerations, and future directions for the integration of radiotherapy and fertility preservation in the care of cancer patients.