Since 1994, HIMAC has carried out clinical studies and treatments for more than 9000 cancer patients with carbon-ion beams. During the first decade of the HIMAC study, a single beamwobbling method, adopted as the HIMAC beam-delivery technique, was improved for treatments of moving tumors and for obtaining more conformal dose distribution. During the second decade, a pencil-beam 3D scanning method has been developed toward an "adaptive cancer treatment" for treatments of both static and moving tumors. A new treatment research facility was constructed with HIMAC in order to verify the developed 3D scanning technology through a clinical study that has been successfully conducted since 2011. As the next stage, a compact heavy-ion rotating gantry with a superconducting technology has been developed for the more accurate and shortercourse treatments. The twenty-year development of the heavy-ion radiotherapy technologies including accelerator technologies with HIMAC is reviewed.