Neonatal radiation therapy represents a highly specialized and evolving branch of medical treatment aimed at addressing oncological conditions in the earliest stages of life. Tailored to the unique physiological and developmental characteristics of newborns, this therapeutic approach employs ionizing radiation to target and eradicate cancerous cells in neonates, who are particularly vulnerable due to their small size, immature organ systems, and rapid growth. The delicate nature of neonatal tissues demands precision and customization in treatment planning, often involving advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) to ensure accurate targeting of Tumours while minimizing damage to surrounding healthy tissues. Collaborative efforts between neonatologists, Paediatric oncologists, and radiation oncology teams are paramount in designing individualized treatment protocols that balance the imperative to eradicate malignancies with the imperative to safeguard the developing organs and tissues of these tiny patients. Striking this delicate balance, neonatal radiation therapy has evolved with technological advancements, incorporating techniques like intensity-modulated radiation therapy (IMRT) and proton therapy to enhance treatment precision and reduce long-term side effects. Moreover, continuous research endeavors are underway to refine protocols, explore novel therapeutic modalities, and unravel the long-term implications of radiation exposure on the neonatal brain and other vital organs. Despite the challenges posed by the unique vulnerabilities of neonates, this evolving field holds promise for improving outcomes in neonatal oncology and contributing to our understanding of cancer treatment across the lifespan. The ethical considerations surrounding neonatal radiation therapy underscore the importance of a multidisciplinary approach, emphasizing meticulous planning, close monitoring, and ongoing research to ensure the optimal balance between therapeutic efficacy and minimizing potential long-term sequelae in these youngest and most fragile patients.