Vertebral hemangiomas (VHs) are the most common benign vascular tumors of the spinal column, often discovered incidentally during imaging for unrelated complaints. While the majority of VHs remain asymptomatic, a minority can become aggressive, leading to pain, neurological deficits, or spinal instability. Management strategies range from observation to surgical intervention, embolization, vertebroplasty, and radiotherapy (RT), with the choice dictated by clinical presentation and imaging findings. Radiotherapy, both in conventional and stereotactic forms, has emerged as a cornerstone in the nonsurgical management of aggressive or symptomatic VHs, offering effective symptom control and local disease stabilization. This chapter provides an in-depth review of the epidemiology, pathophysiology, clinical presentation, diagnostic imaging, and multidisciplinary management of vertebral hemangiomas, with a special focus on the indications, techniques, and outcomes of radiotherapy. Tables and charts summarize key recommendations and dose regimens. A review of the literature and a summary of current best practices are included.