Hadron therapy, such as carbon and helium ions, is increasingly coming to the fore for the treatment of cancers. Such hadron therapy has several advantages over conventional radiotherapy using photons and electrons physically and clinically. These advantages are due to the different physical and biological characteristics of heavy ions including high linear energy transfer and Bragg peak, which lead to the reduced exit dose, lower normal tissue complication probability and the increased relative biological effectiveness (RBE). Despite the promising prospects on the carbon ion radiation therapy, it is in dispute with which bio-mathematical models to calculate the carbon ion RBE. The two most widely used models are local effect model and microdosimetric kinetic model, which are actively utilized in Europe and Japan respectively. Such selection on the RBE model is a crucial issue in that the dose prescription for planning differs according to the models. In this study, we aim to (i) introduce the concept of RBE, (ii) clarify the determinants of RBE, and (iii) compare the existing RBE models for carbon ion therapy.