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Highlights • We analyzed 64 LAPC patients treated with C-ion RT at single institution. • The median survival time and 2-year OS were 25.1 months and 53%. • Only four patients experienced acute grade 3 toxicities. • C-ion RT for LAPC showed relatively favorable outcome and limited toxicity. Abstract Purpose The aim of this study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for unresectable locally advanced pancreatic cancer (LAPC). Methods and materials Patients with LAPC treated with definitive C-ion RT between April 2014 and July 2017 were analyzed retrospectively. The prescribed dose was 55.2 Gy (relative biological effectiveness [RBE] weighted absorbed dose) in 12 fractions. Overall survival (OS), local control (LC), progression free survival (PFS), and toxicity were evaluated. Results Sixty-four patients were enrolled. All patients completed planned course of C-ion RT. The median follow-up time for survivors from the initiation of C-ion RT was 24.4 months (range, 5.1–46.1 months). Median survival time was 25.1 months. Two-year OS, LC, and PFS were 53% (95% confidence interval [CI], 39%–66%), 82% (95% CI, 66%–91%), and 23% (95% CI, 14%–36%), respectively. Four patients experienced acute grade 3 toxicities including 3 gastrointestinal (GI) toxicities. There was no grade 3 or more late toxicity. Conclusions The clinical results of C-ion RT for LAPC at our institution were comparable to those of a recent multi-institutional analysis. [ABSTRACT FROM AUTHOR]