From 1974 to 1984, nine patients with suprasellar germinoma were treated with megavoltage radiation therapy. The entire craniospinal axis was irradiated in all patients, with median doses of 45.6 Gy, 31.6 Gy, and 25.2 Gy delivered to the tumor volume, whole brain, and spinal cord, respectively. Two patients have died (14, 11.5 months) without evidence of tumor: one of uncontrolled endocrine dysfunction due to patient noncompliance, the other of hyperosmolar coma. There have been no tumor recurrences with a median 68-month follow-up among seven survivors. The dose usually recommended for treatment of intracranial germinoma is 50-55 Gy. Our data suggest that 45 Gy may be sufficient, if treatment volume is adequate. Posttherapy endocrine testing is also essential.