Abstract
Radiotherapy is an effective treatment for various cancers, but it can cause significant
side effects on various organ systems, including the reproductive organs, which is
a major concern for women of reproductive age. A well-known long-term effect of oncological
treatment is premature ovarian insufficiency. Another critical but sometimes overlooked
organ at risk in female cancer survivors is the uterus. This review focuses on the
impact of radiotherapy on uterine physiology, highlighting key issues such as the
development of fibrosis and loss of elasticity, vascular damage, and hormonal disruption,
all of which can compromise uterine function. These changes can negatively impact
fertility and pregnancy outcomes, such as miscarriage, preterm birth, and low birth
weight. Limited evidence is also available suggesting that radiotherapy may affect
endometrial receptivity and contribute to abnormal placentation. We conclude by discussing
strategies aimed at mitigating the damage caused by radiotherapy, such as fertility-preserving
treatments and hormonal interventions. A thorough understanding of these effects is
essential for healthcare providers to offer informed support to women who wish to
maintain their fertility and have children following cancer treatment.
Keywords
cancer - radiotherapy - uterus - pregnancy - survivorship
