Background: By virtue of their disease acuity and symptom burden, inpatients are good candidates for radiation therapy but may also be at risk of not benefitting from treatment due to premature treatment discontinuation or early demise. The current study describes the inpatient radiation therapy experience at an academic medical center. Methods: Patients receiving palliative radiotherapy in the hospital at any point in their care form the study population. Dose prescriptions were determined on an individual basis by the faculty radiation oncologist. Brachytherapy, IORT, and radiosurgery cases were excluded. Descriptive data was aggregated for analysis. Results: 315 courses given to 275 inpatients between January 2013 and September 2017 form this analysis. Mean age was 56.5 yrs. 96% began as inpatients. The top hospitalization indications were pain (32%), neurological symptoms (9%), and dyspnea (7%). The top treatment indications were spinal metastases (34%), brain metastases (21%), and non-spine bone metastases (12%). The estimated median survival of the entire group was 8.9 wks (range <1 – 189). Ten courses were given during the terminal hospitalization. The overall rate of treatment non-completion was 18%. Non-completion and survival figures for the most common indications provided. Spine treatments in which shorter courses predominated had a non-completion rate (12%) that was lower than for the overall group. The rate of treatment non-completion was particularly high for brain metastases (28%). Conclusions: Hospitalized patients receiving palliative radiation therapy carry a poor prognosis. Their significant symptom burden and limited life expectancies place them at risk for treatment non completion. While short courses developed for spine irradiation are associated with lower non-completion rates, longer courses seen as appropriate for brain irradiation are associated with particularly high non-completion rates.