Various accelerator-based boron neutron capture therapy (AB-BNCT) systems have been and are being developed worldwide. In Japan, three hospital-based AB-BNCT facilities have been established and have started to treat patients ahead of the rest of the world. The first AB-BNCT system developed in Japan is based on a cyclotron with beryllium target and was developed by Kyoto University and Sumitomo Heavy Industries Ltd. It is marketed under the name NeuCure® and has been installed at South Tohoku BNCT Research Center in Koriyama, Fukushima Prefecture, and Kansai BNCT Medical Center in Osaka. A second system based on a RFQ linear accelerator with lithium target has been developed by Cancer Intelligence Care System Inc. and has been installed at the National Cancer Center Hospital in Tokyo. The boron drug (borofalan (10B) Steboronine®) with BPA as active pharmaceutical ingredient has also been developed in Japan by Stella Pharma Corp. This compound was approved for clinical application by the government in March 2020 and is now marketed. Phase II clinical trials using the NeuCure® system for brain tumor and head and neck cancers were completed in 2018, and regulatory approval was obtained for the clinical use of the AB-BNCT system in March 2020. BNCT for recurrent and inoperable head and neck cancer treated at the NeuCure® facility and using Steboronine® is now reimbursed by the national healthcare system.