Radioimmunotherapy with radiolabeled monoclonal antibodies is increasingly effective for hematopoietic tumors, with a number of investigators reporting persistent major responses. Radioimmunotherapy for solid tumors has been more difficult and only an occasional major response has been reported and these have so far not been persistent. Toxicity is predominantly hematopoietic, with platelets being most sensitive to the effects of radiation. Even at ultra-high doses (up to 28 mCi/kg of 131I), second organ toxicity has not been reached. Rational approaches to dose planning are becoming possible with improvements in dosimetry, based on quantitative SPECT and PET imaging. Current therapeutic indices for tumor/marrow, the most radiosensitive organ, are in the range of 5-10 to 1. This is probably still too low for curative treatment of solid tumors, and further refinements, perhaps based on novel antibody formulations, are needed.