Abstract. The purpose was to evaluate efficacy and safety of carbon ion radiotherapy (C-ion RT) in patients with locally advanced olfactory neuroblastomas (ONBs). This study was a sub-analysis of the Japan Carbon-Ion Radiation Oncology Study Group Study (1402 HN, UMIN000024473). Clinical data of T4 ONBs treated with C-ion RT at fourOlfactory neuroblastoma (ONB) of the head and neck is a rare malignant tumour that arises from the olfactory neuroepithelium in the upper nasal cavity with extension into the skull base, into the orbit and to the intracranial space (1, 2). Surgery is considered a curative treatment for localized ONB, while postoperative radiotherapy (RT) is necessary for advanced ONBs. Definitive RT alone is considered insufficient therapy for ONBs (3). In advanced cases, intracranial extension may pose a surgical challenge (4). Surgical resection followed by postoperative RT is associated with reduced local recurrence (5).Although ONB has been traditionally regarded as a radioresistant tumour, RT has widely been used as part of the treatment algorithm in adjuvant and definitive settings.Compared to photons, carbon ions (C-ions) offer a higher linear energy transfer and greater relative biological effectiveness (RBE) and therefore provide a higher probability of tumour control. The physical characteristics of C-ions, such as their Bragg peak and small lateral scattering, are theoretically superior to those of photons in that C-ions can allow a more localized delivery of the radiation dose.This study is the first report for ONBs treated by C-ion RT. C-Ion RT for various head and neck radioresistant malignancies has shown excellent results. Jingu et al. reported clinical results of 37 patients with malignant melanoma of the head and neck who received C-ion RT with concurrent chemotherapy. The 3-year local control (LC) and overall survival (OS) rates were 81.1% and 65.3%, respectively (6). Koto et al. reported 3-year LC and OS rates of 76.9% and 59.1%, respectively, in 22 patients with locally advanced sinonasal adenocarcinoma + reated with C-ion RT (7). Therefore, C-ion RT might be a useful and potentially curative option for unresectable head and neck tumours, including ONBs.In November 2003, following a clinical trial, the Ministry of Health, Labour and Welfare in Japan approved C-ion RT as a highly advanced medical technology. As of the end of 2014, there were four C-ion facilities functioning in Japan