Sex- and gender-related aspects of patient safety in radiation oncology: a scoping review

Background Radiation oncology is a safety-critical clinical discipline in which sex-related biological attributes and gender-related social processes may influence treatment planning, treatment effects, symptoms, care use, and follow-up. Their relevance to patient safety across the radiation-oncology pathway remains incompletely characterized. We examined evidence for sex- or gender-related aspects affecting safety in radiation oncology. Methods We conducted a scoping review of original studies identified through a PubMed search conducted on 22 July 2026 and through backward reference-list searching. Data were charted at the level of individual findings, classified according to the operationalization of sex and gender, and mapped to four published patient-safety categories and 27 subcategories. Synthesis was descriptive; no meta-analysis, formal critical appraisal, or certainty assessment was undertaken. Results The PubMed search yielded 159 records. Thirty-two database-identified studies and five citation-derived original studies met the eligibility criteria. The 37 included studies contributed 49 reportable empirical findings: 33 differences or associations, 10 mixed findings, and six statistically non-significant findings. Forty-four findings were clinical or technical outcome signals with potential safety relevance and five directly concerned care processes. Evidence mapped to six patient-specific subcategories. Twenty studies were classified as analyses of sex and 17 as unclear; no study operationalized multidimensional gender. Conclusions The targeted search, including five citation-derived studies, may selectively capture studies reporting sex only as a covariate. The retrieved evidence indicates that sex can be relevant to the safe design and delivery of radiotherapy, but the evidence is fragmented, predominantly observational, and largely limited to clinical outcome associations. Prospective studies should test whether clearly defined sex- and gender-informed care processes improve safety.