OBJECTIVES: To review published cost-effectiveness studies which evaluate radiotherapy in individuals with breast, cervical, colorectal, head and neck, or prostate cancer.  To compare the economic methods used with the guidelines used in the appraisal programme for the National Institute of Health and Care Excellence (NICE) in the UK. METHODS: Systematic searches of seven databases (Medline, EMBASE, CDSR, NHSEED, HTA, DARE and EconLit) were conducted in July 2012.  In addition, research registers, the NICE website and conference proceedings were searched.  Studies that reported results of economic evaluations of radiotherapy interventions in terms of incremental quality adjusted life-years or life-years for individuals diagnosed with cancers were included.  The quality of these studies was assessed in terms of meeting, essential, preferred and UK NICE-specific requirements for economic evaluations. RESULTS: 29 studies satisfied the inclusion criteria (breast=14, colorectal=2, prostate=10, cervical=0, head and neck=3).  The majority (13) of the studies were set in the US with just 2 conducted in the UK.  Considering essential methodological criteria, only 3 (10%) studies used estimates for clinical effectiveness which were identified by systematic literature review.  Just a quarter (8/29) used health related quality of life data from patients with the particular cancers.  While the majority of studies used one-way sensitivity analyses, only a third (10/29) reported the results of a full probabilistic sensitivity analysis.  Additional essential criteria such as the use of an appropriate horizon, a clear description of both the comparators and the patient group indication were generally satisfied.  However, as only 2 of the studies were conducted in the UK, the majority of the UK NICE specific requirements were not met. CONCLUSIONS: This review indicates there is little robust evidence of the cost-effectiveness of radiotherapy interventions in these cancers and very little evidence which could be used to support decision-making in the UK.