The mediastinum is the midline compartment of the thoracic cavity that separates the two pleural cavities. It contains vital organs like the heart and serves as a conduit for structures to pass in and out of the thoracic cavity [1, 2]. Mediastinal tumours are rare and heterogeneous since they can arise from any of the mediastinal structures. In adults, anterior mediastinal tumours like thymic epithelial neoplasms, lymphomas and germ cell tumours are commonest. In children, more than half of the tumours are neurogenic in origin arising in the posterior mediastinum [3]. Disease management strategies and outcomes vary with the type of tumour. While surgery is the mainstay of treatment in patients with thymic epithelial neoplasm, teratoma and low-risk neuroblastoma, systemic chemotherapy has an important role in patients with mediastinal lymphoma, germ cell tumour and high-risk neuroblastoma. Radiotherapy should be considered in patients with unresectable, borderline resectable and high-risk thymoma and as a consolidative strategy in patients with mediastinal lymphoma and high-risk neuroblastoma. Proper attention to the nuances of planning and delivery of thoracic radiotherapy aids optimisation of disease control and minimisation of acute and late effects of treatment, thereby improving health related quality of life.