[en] Highlights: • One-third of pediatric tumor patients require radiotherapy. • High pediatric radiotherapy utilization rate in a middle-income country. • Pediatric soft tissue sarcoma requires the highest radiotherapy utilization rate. • Palliative radiotherapy is frequently used for brainstem glioma patients. • Palliative radiotherapy is underutilized in childhood cancers. Although the radiotherapy utilization rate (RUR) is determined for most adult cancers, it is seldom reported in childhood tumors, particularly in low- and middle-income countries (LMIC) where the majority of pediatric cancer patients reside. This study aims to investigate the real-life RUR for pediatric tumors in a large LMIC center.