Primary tumors in the spine include a diverse collection of osseous, intradural and intramedullary tumors, across a spectrum from benign to malignant. Commonalities include the multidisciplinary challenge of integrating surgical resection, for which the critical anatomy often prevents gross tumor resection, and radiotherapy, which has limitations imposed by the dose tolerance of the spinal cord. Finally, the radiation sensitivity of each tumor varies widely and many practice patterns are ultimately extrapolated from more complete data for radiotherapy of the same histology at other sites, typically intracranial. In this chapter, we will cover each tumor type separately to illustrate key principles of decision making and guidelines for radiation planning, though ultimately there remains wide room for physician judgment in radiation plan development, given the rarity of the tumor types, significant practice variation, and lack of clear evidence-based data supporting one paradigm over another. Finally, we acknowledge differing practice patterns in the field, which we attempt to describe, while also illustrating the current practice patterns at our own center.