Metaiodobenzylguanidine (MIBG) targeted radiotherapy is a promising treatment for malignant phaeochromocytoma. It is an effective palliative therapy and may influence prognosis by reducing tumour metabolic function and preventing excessive catecholamine secretion. Repeated treatments are necessary to achieve tumour arrest and disease regression, and it is essential that patients are followed closely for life. Toxicity is limited to myelosuppression but is cumulative. Bone marrow harvesting is recommended for all patients who are likely to undergo repeated treatments. Heightened clinical awareness and easier diagnosis of malignancy using MIBG scintigraphy are likely to result in an increasing number of referrals for treatment. It is essential, therefore, that experience is pooled from individual centres and that patients are treated according to agreed protocols, so that results can be directly compared.