Gender-affirming Surgery and Cancer: Considerations for Radiation Oncologists for Pelvic Radiation in Transfeminine Patients

Access to gender-affirming surgery is increasing for many transgender and nonbinary people in the US, and radiation oncologists must be equipped to care for cancer patients who have undergone such surgery in the region of their planned radiation treatment field. There are currently no available guidelines for radiation treatment planning after gender-affirming surgery, and most oncologists do not receive training in the unique needs of transgender patients with cancer. We review common gender-affirming genitopelvic surgeries for transfeminine patients including vaginoplasty, labiaplasty, and orchiectomy and summarize the existing literature on treatment of cancers of the neovagina, anus, rectum, prostate, and bladder in these patients. We also describe our systematic treatment approach for pelvic radiation treatment planning and its rationale.