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To evaluate the long-term effectiveness of radiation therapy (RT) as an adjuvant or alternative treatment for patients with aneurysmal bone cyst (ABC).The medical records of 12 patients who received RT at the University of Florida for ABC between 1964 and 2011 were reviewed and patients were contacted, when possible, for follow-up. Follow-up duration ranged from 3 to 36 years (median, 20.5 y). Patient age at the time of RT ranged from 3 to 23 years (mean, 12.75 y), with 7 females and 5 males. Four patients were treated for recurrent ABCs. Three patients were treated with surgical interventions (intralesional curettage, subtotal resection, or selective arterial embolization) before RT, and the rest received open biopsy only. The prescribed doses ranged from 20 to 60 Gy (mean, 30.15 Gy). Ten (83.3%) patients received between 1.5 and 2.0 Gy per fraction.All patients were doing well and free of any adverse reaction to RT as of the latest follow-up, including 1 who passed away from cardiac problems 34 years since completing RT and 3 who were lost to follow-up (at 16, 16, and 19 y) but were doing well at the last follow-up.RT continues to result in an excellent prognosis for patients with ABC who receive either RT alone or adjuvant RT after surgery.