Optimal treatment for giant cell tumors in the axial skeleton (GCTS) remains challenging. Surgical excision remains the treatment of choice, but the potential spinal cord injury may limit the extent of resection. We report the long-term results of treatment of six patients diagnosed with giant cell tumor of the spine treated with radiotherapy and review the literature regarding therapy. Between 1971 and 1995, six patients with GCTS were treated with conservative surgery and radiotherapy. The surgery consisted of either biopsy or subtotal resection of tumor. The involved vertebrae were then irradiated with doses ranging from 3000 to 5400 cGy. The mean follow-up was 13 years, and three of six patients had follow-up of 17 or more years. Five of six patients are alive with no evidence of disease. One is alive with disease, although it is not clinically apparent. No patient was lost to follow-up. We conclude that radiotherapy is useful in the management of GCTS and that conservative surgery with local radiotherapy is a reasonable treatment alternative for tumors that cannot be completely excised or in which surgery would result in significant functional morbidity. Although there is no clear dose response, review of the literature suggests that doses ranging from 3500 to 4500 cGy are safe and effective in controlling giant cell tumor.