Objective: To review the use of radiotherapy in cancer care, especially the role of radiation in palliative care. Quality of evidence: MEDLINE was searched from January 1966 to January 2004. Relevant articles evaluating indications for radiotherapy were reviewed. This paper describes use of radiotherapy based on well established current radiotherapy practices and level I and II evidence. Main message: A substantial number of patients seeing family physicians develop cancer or die of it. Despite its effectiveness, radiotherapy remains underused in management of cancer patients. Broad uses of radiotherapy in cancer care include curative treatment, palliative symptom control, and management of oncologic emergencies. Radiotherapy can be especially effective for treating common complications of cancer, including painful bone and soft tissue metastases, hemoptysis, dyspnea, dysphagia, brain metastases, and spinal cord compression. Conclusion: Radiotherapy is a vital aspect of both curative and palliative cancer treatment. Understanding the basics of radiotherapy can assist family physicians in providing complete care for their cancer patients.