Clinical characteristics of radiation oncology in Korea during past 10 years.

Abstract

To understand trends in the clinical characteristics of radiation oncology over the last 10 yr in Korea, annual survey questionnaires were sent to all of Korean radiation oncology facilities since 1990. Questionnaires addressed basic radiation therapy facilities and the clinical information. Responses were obtained from all facilities, and data collected from 1997 to 2006 was analyzed. The numbers of new patients that have undergone radiation therapy and the numbers of hospitals with a department of radiation oncology have steadily increased over the past 10 yr, and totaled 37,215 patients and 60 hospitals, respectively, in 2006. However, the proportion of patients irradiated among total cancer patients has remained below 30% over the last 10 yr. The numbers of prostate cancer, breast cancer, and hepatoma have increased by more than 3 fold over the past 10 yr. Moreover, the percentage of irradiated patients treated by brachytherapy was 10.3% in 1997, but this gradually fell to only 4.2% in 2006. The information collected described the role played by radiation oncology in Korea. Continuous surveys are required to enable trends to be detected.

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INTRODUCTION
The Korean Institute of Radiological and Medical Sciences
(KIRAMS) has conducted an annual nationwide survey to
collate radiation oncology statistics since 1986 under the aus-
pices of the Korean Society for Therapeutic Radiology and
Oncology (KOSTRO). The survey requests information on
human resources, radiation therapy equipment, facilities, and
the clinical loads placed on radiation oncology department on
a nationwide basis. Survey results are published annually in
the Journal of KOSTRO (1-6), and represent a useful resource
for understanding the infrastructure (7, 8) and characteristics
of radiation oncology services in Korea over the past 20 yr.
In 1997, we described the infrastructures of departments of
radiation oncology in Korea, and compared these with Japanese
and American counterparts (9). However, progress in radio-
therapy has developed rapidly over the past 10 yr, and especial-
ly in Korea, radiotherapy has evolved qualitatively and quan-
titatively. Accordingly, to understand clinical trends in radi-
ationoncology over the past 10 yr and estimate future trends,
we analyzed accumulated clinical data over the past 10 yr.
MATERIALS AND METHODS
Before 2000, survey questionnaires were prepared in hard
copy form and forwarded by mail annually to appropriate
personnel (primarily, chief of radiation oncologists) in radia-
tion oncology facilities. The completed survey questionnaires
were returned by mail. However, from 2000 the web-site of
the department of radiation oncology at the Korea Cancer
Center Hospital (KCCH) has included a means of collecting
annual national statistics from departments of radiation oncol-
ogy. Data are electronically entered deposited in the web site
by designated personnel.
However, all questionnaires issued over the past 10 have
been identical in terms of a series of questions. The first ques-
tionnaire requested details on basic radiation therapy facili-
ties. The second questionnaire inquired clinical details of new
patient numbers treated in department of radiation oncolo-
gy in a calendar year (January through December) and details
of sites treated. Sites were classified as follows: primary brain
and spinal cord, head and neck (larynx, oral cavity, nasophar-
ynx, oropharynx, hypopharynx, maxillary sinus, salivary gland,
1165
Young Hoon Ji
Haijo Jung
and Chul Koo Cho
1,2, Mi Sook Kim
1, Seong Yul Yoo
2
1,2,
2,
Korea Institute of Radiological & Medical Sciences,
Division of Radiation Cancer Research1, Research
Institute of Radiological & Medical Sciences;
Department of Radiation Oncology2, Korea Cancer
Center Hospital, Seoul, Korea
Address for correspondence
Mi Sook Kim, M.D.
Division of Radiation Cancer Research, Research
Institute of Radiological & Medical Sciences,
Department of Radiation Oncology, Korea Cancer
Center Hospital, Korea Institute of Radiological &
Medical Sciences, 215-4 Gongneung-dong,
Nowon-gu, Seoul 139-706, Korea
Tel : +82.2-970-1264, Fax : +82.2-970-2412
E-mail : mskim@kcch.re.kr
This work was supported by the Nuclear R&D Programs
funded by the Korea government (Ministry of Education,
Science and Technology).
J Korean Med Sci 2009; 24: 1165-9
ISSN 1011-8934
DOI: 10.3346/jkms.2009.24.6.1165
Copyright � The Korean Academy
of Medical Sciences
Clinical Characteristics of Radiation Oncology in Korea during Past
10 Years
To understand trends in the clinical characteristics of radiation oncology over the last
10 yr in Korea, annual survey questionnaires were sent to all of Korean radiation
oncology facilities since 1990. Questionnaires addressed basic radiation therapy
facilities and the clinical information. Responses were obtained from all facilities,
and data collected from 1997 to 2006 was analyzed. The numbers of new patients
that have undergone radiation therapy and the numbers of hospitals with a depart-
ment of radiation oncology have steadily increased over the past 10 yr, and totaled
37,215 patients and 60 hospitals, respectively, in 2006. However, the proportion of
patients irradiated among total cancer patients has remained below 30% over the
last 10 yr. The numbers of prostate cancer, breast cancer, and hepatoma have in-
creased by more than 3 fold over the past 10 yr. Moreover, the percentage of irra-
diated patients treated by brachytherapy was 10.3% in 1997, but this gradually fell
to only 4.2% in 2006. The information collected described the role played by radia-
tion oncology in Korea. Continuous surveys are required to enable trends to be
detected.
Key Words : Radiation Oncology; Structure; Data Collection; Facility; Patient Loads
Received : 24 October 2008
Accepted : 31 December 2008

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1166 Y.H. Ji, M.S. Kim, H. Jung, et al.
nasal cavity, eye and orbit, lip, and non-specified), esophagus,
lung, breast, pancreas, hepatobiliary, genitourinary (prostate,
ureter and bladder, kidney, testis, urethra, and non-specified),
gynecology (uterine cervix, uterine corpus, ovary and tubes,
vagina, and non-specified), rectum including anus, soft tis-
suesarcoma, leukemia and lymphoma, metastasis (bone, brain,
lymph node, and non-specified), and others. The third ques-
tionnaires included number of patients receiving brachyther-
apy, which was classified by treatment method, e.g., intra-
cavitary radiation therapy (ICR), and others, such as, inter-
stitial, intraluminal, and mold brachytherapy.
In the case of non-response facilities, multiple mailings and
telephone calls ensured 100% responses from all facilities.
Returned forms were then reviewed for completeness and
logical consistency. Follow-up telephone calls were made to
clarify inconsistent data or to obtain missing information on
key questions. Logic checks were conducted after data entry
to detect errors. All data collected were entered into a com-
puter program at KOSTRO by authorized staff. We selec-
tively analyzed the characteristics of facilities and patients
entered into the computer database from 1997 to 2006 to
evaluate trends over the past 10 yr.
RESULTS
Facilities and distributions of patients in 2006
In 2006, 60 hospitals operated a department of radiation
oncology in Korea (population of Korea: 48,297×103in
2006). Thirty of these facilities (50.0%) were located in cap-
ital area including the city of Seoul, and Incheon (total pop-
ulation of 20,842×103in 2006), and the remaining 30 facil-
ities(50.0%) were located in provincial areas (total population
of 27,455×103in 2006). The percentages of hospitals treat-
ing <250, between 250 and 499, between 500 and 999, and
>1,000 new patients per year, were 11 (18.3%), 26 (43.3%),
16 (10%), and 7 (11.6%), respectively, as showed in Table 1.
The distribution of patients by treatment site in 2006 is
shown in Table 2. The most frequent sites for the 37,215
patients that underwent radiation therapy were: breast 6,948
(18.7%), metastasis (brain, bone, lymph node, and others)
6,938 (18.6%), lung 3,772 (10.1%), gynecology 3,263 (8.8
%), rectum 3,242 (8.7%), head and neck 2,769 (7.4%), hep-
atobiliary 2,007 (5.4%), primary brain and spinal cord 1,683
(4.5%), and esophagus 959 (2.6%), as showed in Table 2.
Clinical trends over the past 10 yr
Fig. 1 shows trends in the number of new patients treated
in radiation oncology facilities. The total number of new pa-
tients treated has steadily increased over past 10 yr to 37,215
Annual new patients No. (%) of hospitals
Table 1. Numbers of radiation oncology facilities by new patient
numbers in 2006
Treatment sitesNo. (%) of patients
Primary brain & spinal cord
Head & Neck
Larynx
Oral cavity
Nasopharynx
Oropharynx
Hypopharynx
Maxillary sinus
Salivary gland
Nasal cavity
Eye & orbit
Lip
Other
Subtotal
Esophagus
Lung
Breast
Pancreas
Hepatobiliary
Genitourinary
Prostate
Ureter & Bladder
Kidney
Testis
Urethra
Other
Subtotal
Gynecology
Uterine cervix
Uterine corpus
Ovary & tubes
Vagina
Other
Subtotal
Rectum
Soft tissue sarcoma
Leukemia & lymphoma
Metatasis
Bone
Brain
Lymph node
Other
Subtotal
Other
Total
1,683 (4.5)
622 (1.7)
419 (1.1)
364 (1.0)
341 (0.9)
273 (0.7)
163 (0.4)
143 (0.4)
107 (0.3)
94 (0.3)
17 (0.0)
226 (0.6)
2,769 (7.4)
959 (2.6)
3,772 (10.1)
6,948 (18.7)
540 (1.5)
2,007 (5.4)
699 (1.9)
263 (0.7)
110 (0.3)
72 (0.2)
26 (0.1)
7 (0.0)
1,177 (3.2)
2,676 (7.2)
378 (1.0)
104 (0.3)
46 (0.1)
59 (0.2)
3,263 (8.8)
3,242 (8.7)
386 (1.0)
1,172 (3.2)
3,648 (9.8)
2,115 (5.7)
706 (1.9)
469 (1.3)
6,938 (18.6)
2,359 (6.3)
37,215 (100)
Table 2. New patients and cancer sites in 2006
(Parenthesis) indicate the percentages of new patients versus all new
patients.
<250
250-499
500-999
>1,000
Total
11 (18.3)
26 (43.3)
16 (26.7)
7 (11.7)
60

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Clinical Characteristics of Radiation Oncology in Korea during Past 10 Years1167
in 2006 as compared with 18,857 in 1997. The number of
new patients per radiation oncologist (staff and fellow) was
analyzed to 220 on an average in 1997 and 1998, and it was
increased to 285 on an average in 2005 and 2006.
The statistics of the Korean Ministry of Health and Wel-
fare show that numbers of new cancer patients registered per
annum were 101,025, 101,385, 110,804, and 116,034 over
the 1999 to 2002 period, respectively, indicating that the
percentages of total cancer patients irradiated were 21.7%,
21.0%, 21.7%, and 22.5%, respectively. Unfortunately, can-
cer registration statuses were not available for 2003, 2004,
and 2005. However, for 2006 the statistical data of the Health
Insurance Review and Assessment Service (http://www.hira.
or.kr) showed that 21.8% of new cancer patients were irradi-
ated, i.e., 37,215 of 170,365 cancer patients underwent radi-
ation therapy. Therefore, over the past 10 yr, percentages of
cancer patients irradiated have been consistently below 30%.
Fig. 2 shows clinical trends in the numbers of new oncol-
ogy patients that received radiation treatment on the primary
lesions during the past 10 yr. Notably, metastases and the
breast, lung, gynecology, rectum, and head and neck cancers
were most prevalent. Moreover, metastatic lesions, including
those of the brain and bone, lymph node, etc. have account-
ed for approximately 19% of all irradiated patients. In addi-
tion, the incidences of breast cancer and metastasis have in-
creased rapidly from 2000.
The increasing rates of major cancer over the past 10 yr are
shown in Fig. 3. The prostate, breast, hepatobiliary, metastat-
Fig. 1. The number of radiation oncology facilities and new patients
per year over the past 10 yr (Provincial area includes all regions
other than the Seoul, Incheon, and neighboring region of Gyeong-
gi-do).
Fig. 2. New cancer patients that underwent radiotherapy by lesion
type.
No. of patients
No. of radation oncology facilities
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
70
60
50
40
30
20
10
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Years
New patients
National total
Breast
Metastasis
Lung
Gynecology
Rectum
Head & Neck
Hepatobiliary
Primary brain & spinal cord
Genitourinary
Leukemia and lymphoma
Esophagus
Pancreas
Soft tissue sarcoma
Others
(Seoul city)
Province area
Capital area
No. of new patients
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
19971998 199920002001200220032004 20052006
Years
Fig. 3. Fold increases in the incidences of major cancers over the
past 10 yr since 1997.
Increased ratio during 10 yr
5.0
4.0
3.0
2.0
1.0
0.0
1997 1998199920002001
Years
2002 2003200420052006
Prostate
Breast
Hepatobiliary
Metastasis
Pancreas
Rectum
(Parenthesis) indicates percentages of radiotherapy treated patients that received brachytherapy for total new patients that received radiotherapy
treatment. ICR, Intracavitary Radiation Therapy.
Treatment
methods
199719981999200020012002 200320042005 2006
New patients/year
ICR
Others
Total
1,758
277
2,035
(10.3%)
for
19,773
1,627
330
1,957
(9.7%)
for
20,226
1,614
286
1,900
(8.6%)
for
22,008
1,507
138
1,645
(7.7%)
for
21,345
1,5971,542
103
1,645
(6.3%)
for
26,218
1,716
176
1,892
(7.0%)
for
26,920
1,462
155
1,617
(5.6%)
for
28,789
1,412 1,445
116
1,561
(4.2%)
for
37,215
95 97
1,692
(7.0%)
for
24,125
1,509
(4.7%)
for
31,847
Table 3. Numbers of new patients treated using brachytherapy over the past 10 yr

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1168Y.H. Ji, M.S. Kim, H. Jung, et al.
ic, pancreatic, and rectal cancer have shown the most notable
increases during recent years. In fact, the incidences of the
prostate, breast, and hepatobiliary cancer in 2006 have in-
creased by more than 3 fold over the past 10 yr.
Only 1,561 new patients received brachytherapy in 2006
(Table 3). While 10.3% of total irradiated patients received
brachytherapy in 1997, only 4.2% did so in 2006.
DISCUSSION
In Korea, radiation therapy is administered by individual
hospital-based facilities. Based on the 2006 annual statistics
for the departments of radiation oncology in Korea, the num-
ber of radiation oncology facilities in Korea was 60 and the
number of facilities per million of the population (facility
resource) was 1.24, which compared with 3.36 in France in
1996, 5.31 in the U.S.A. in 1989, and 3.04 in Japan in 1990
(10, 11). Over the past 10 yr the number of radiation oncol-
ogyfacilities in Korea has increased by 1.43 fold in both capi-
tal area (Seoul city, Incheon city, and neighboring area of
Gyeonggi-do) and provincial areas. However, the number of
radiation therapy facilities in Seoul, capital city of Korea,
increased by only 1.12 fold over the past 10 yr, and therefore,
it is believed to have reached saturation.
The Health Insurance Review and Assessment Service (12)
reported in 2008 that the major seven cancer sites are; the
stomach (20.8%), colorectum (15.8%), liver (15.5%), lung
(14.3%), thyroid (10.8%), breast (9.4%), and bladder (3.5%)
in 2006. However, major cancer sites treated at departments
of radiation oncology were reported to be (in descending order);
the breast, metastatic, lung, gynecology, rectum, head and
neck, and hepatobiliary. Thus, there appears to be a discrep-
ancy between irradiated cancer patients in departments of
radiation oncology and all cancer patients, which appears to
be the result of the limited role of radiation therapy in gas-
tric cancer, hepatoma, colon cancer, and thyroid cancer, which
are common in Korea.
Trends in radiation therapy over the past 10 yr show that
the number of irradiated patients with primary lesions of
breast cancer, hepatoma, and prostate cancer, and metastasis
have increased more than 2.5 times. However, when cancer
incidence in 2006 was compared with that in 2002 using
the statistics of the Ministry of Health and Welfare, Repub-
lic of Korea only the incidence of thyroid cancer was found
to have increased by more that 2-fold (13). Therefore, these
rapid increases in breast cancer, hepatoma, and prostate can-
cerare presumed to have been caused by the adoption of mul-
timodality treatments and the increased role of radiation ther-
apy in the treatment of these cancers. However, the percent-
age of patients underwent radiation therapy among total new
cancer patients did not yet exceed 30%, which is a very low
number compared to 60% in the U.S.A. (11, 14). Further-
more, in the future, the cancer incidence will increase due
to aging of the Korean population, and this with changes in
disease management and radiotherapeutic developments will
increase demand for radiation therapy. Thus, approximately
40% of all total cancer patients are likely to require radiother-
apy in 10 yr time.
Brachytherapy, including interstitial and intracavitary radi-
ation, has traditionally been used to administer higher doses
selectively to tumors to achieve local control. However, due
to experiences of increased invasiveness compared to exter-
nal beam, especially in interstitial brachytherapy, the propor-
tions of the patients that undergo brachytherapy among total
irradiated patients have reduced, e.g., from 10.3% in 1997
to 4.2% in 2006. This status of brachytherapy is similar in
Japan (3% of radiotherapy treated patients in 2003) (15).
We believe that the described collation of information annu-
ally from nationwide hospitals with a department of radia-
tion oncology is unique. The cooperative efforts of staff mem-
bers at these departments nationwide have ensured the suc-
cess of this survey over 10 yr. The information obtained pro-
vides an overview of the real role of radiation oncology in
Korea. It is hoped that the present study will aid those plan-
ning administrative policies in radiation oncology by provid-
ing directions for future developments. Future surveys are
required to strengthen our abilities to predict future trends
based on analytic approaches.
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