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Pelvic insufficiency fractures after radiation therapy are a long-known consequence of tumour irradiation in the pelvic area. Considering their frequency, especially in the sacral region, they are still often hard to diagnose due to their unspecific manifestation. In this literature review we gathered data on the etiology, incidence rate, risk factors, symptoms, diagnostics, treatment and prevention of pelvic insufficiency fractures after radiation therapy. As we were unable to find standardized recommedations, we attempted to use the data to summarize and present conclusions that could be of use in everyday radiation therapy clinical practice.