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Late grade 2 and grade 3 genitourinary and gastrointestinal toxicity rates were 9 and 0.3%, and 0.3, and 0%, respectively. CONCLUSIONS The present protocol of carbon ion radiotherapy for prostate cancer provided low genitourinary and gastrointestinal toxicity with good biochemical control within 5 years. TRIAL REGISTRATION University Medical Information Network Clinical Trial Registry number UMIN000003827.BACKGROUND Given the aging of the population, nephrologists are ever more frequently assisting nonagenarians with acute kidney injur