Book excerpt: This book serves as a practical guide for the use of carbon ions in cancer radiotherapy. On the basis of clinical experience with more than 7,000 patients with various types of tumors treated over a period of nearly 20 years at the National Institute of Radiological Sciences, step-by-step procedures and technological development of this modality are highlighted. The book is divided into two sections, the first covering the underlying principles of physics and biology, and the second section is a systematic review by tumor site, concentrating on the role of therapeutic techniques and the pitfalls in treatment planning. Readers will learn of the superior outcomes obtained with carbon-ion therapy for various types of tumors in terms of local control and toxicities. It is essential to understand that the carbon-ion beam is like a two-edged sword: unless it is used properly, it can increase the risk of severe injury to critical organs. In early series of dose-escalation studies, some patients experienced serious adverse effects such as skin ulcers, pneumonitis, intestinal ulcers, and bone necrosis, for which salvage surgery or hospitalization was required. To preclude such detrimental results, the adequacy of therapeutic techniques and dose fractionations was carefully examined in each case. In this way, significant improvements in treatment results have been achieved and major toxicities are no longer observed. With that knowledge, experts in relevant fields expand upon techniques for treatment delivery at each anatomical site, covering indications and optimal treatment planning. With its practical focus, this book will benefit radiation oncologists, medical physicists, medical dosimetrists, radiation therapists, and senior nurses whose work involves radiation therapy, as well as medical oncologists and others who are interested in radiation therapy.