The role of radiotherapy in the management of patients with craniopharyngiomas is still controversial. Many articles have been published reviewing retrospective patient information with subsequent treatment recommendations which are not randomized and are biased. Treatment at the University of California, San Francisco, with radiation and surgery yields a 10-year disease-free survival of 77%. No difference in overall survival was found based on sex, age, or type of surgery. A review of the literature shows that radiation added to surgery results in a 50–80% disease-free survival. Patients undergoing a complete resection may be observed for subsequent recurrence. If a subtotal resection or biopsy is obtained, that patient should be irradiated with modern techniques to a dose of 5,400 cGy at 180 cGy/fraction.