Abstract Ion beams represent a promising radiotherapy modality for the treatment of deep seated tumours. Compared to conventional photon beams, in particular beams of heavier ions like e.g. carbon show several advantages which are related to their different physical and radiobiological properties: • The dose increases with penetration depth and shows a sharp distal fall off at the end of the particle range, i.e., the depth dose profile is inverted compared to photon beams. • They exhibit an increased biological effectiveness in particular at the end of their range and thus in the target volume. • The spatial distribution of stopping particles can be monitored by means of PET-techniques making use of the small amount of radioactive projectile fragments. Ion beams were first used for medical applications in 1954 in Berkeley. Since then, several treatment facilities for tumour therapy have been established worldwide, and approximately 25 000 patients have been treated with protons and 3000 patients with heavier ions successfully. As an example, the specific advantages of the heavy ion therapy facility at GSI Darmstadt established in cooperation with the Radiological Clinics and DKFZ Heidelberg and FZ Rossendorf will be described. In contrast to most existing facilities, it is based on an active beam delivery system, using magnetic deflection of a pencil beam (raster scan) and accelerator energy variation to adjust the penetration depth. Thus, an optimal conformation of the dose to the target volume is achieved. PET-measurements allow for a quasi on-line monitoring of the 3D distribution of stopping particles and in particular of the position of the distal edge of the dose distribution. Furthermore, in the treatment planning procedure the radiobiological properties of ion beams are taken into account in great detail. In December 1997, patient treatments started at GSI, and up to now 42 patients were treated with carbon ions alone or in a mixed carbon/photon beam regime.