BACKGROUND Focal or total skin radiation therapy can be used to treat mild to refractory cutaneous T-cell lymphoma. OBJECTIVE To report the broad therapeutic benefit of radiation therapy for cutaneous T-cell lymphoma. METHODS Retrospective, single-institution review of outcomes for skin-directed radiation therapy. RESULTS Skin-directed radiation therapy showed a 99% response rate and 80% complete response rate after treatment regardless of involvement, severity, histopathologic subtype, dose, or fractionation. The overall in-field recurrence rate was 15%, and median time to recurrence was 296 days (range, 1-1884 days). Focal and hypofractionated regimens were similarly associated with disease response and rare toxicity. Short-term rates of secondary skin cancer after treatment were comparable to expected incidence in a patient population without radiation. CONCLUSIONS Large total number of treatments courses compared with overall number of patients. Heterogenous mix of treatment regimens (no standardization of dose or fraction number). CONCLUSIONS Radiation therapy is a well-tolerated treatment option for properly selected patients with cutaneous T-cell lymphoma.