Radiation therapy statistics in Korea in 2022 and 2023

Article information

Radiat Oncol J. 2026;.roj.2026.00717

Publication date (electronic) : 2026 August 24

doi : https://doi.org/10.3857/roj.2026.00717

Jin-Kyu Kang¹, Won Il Jang^,1, Mi-Sook Kim¹, Kum-Bae Kim¹, Hee Jin Kim², Jung Young Kim², Eunji Kim³, Young-Joo Shin⁴, Jaesun Yoon⁵, Informatics Committee of the Korean Society for Radiation Oncology

¹Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea

²External Strategy Team, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea

³Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

⁴Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea

⁵Department of Biostatistics, Korea University, Seoul, Republic of Korea

Correspondence: Won Il Jang Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea Tel: +82-2-970-1262 E-mail: zzang11@kirams.re.kr

Received 2026 June 18; Accepted 2026 July 13.

Abstract

Introduction

Cancer remains the leading cause of death in Korea, accounting for 22.4% of all deaths in 2022 and 24.2% in 2023 [1,2]. According to the Korea Central Cancer Registry, 282,047 patients were newly diagnosed with cancer in 2022 and 288,613 in 2023 [3,4]. As the cancer burden continues to grow with rapid population aging, the importance of radiation therapy (RT) as an essential component of cancer treatment has become increasingly recognized.

Accurate national statistics on RT utilization (RTU) are critical for healthcare planning, resource allocation, and evaluation of treatment trends. In Korea, comprehensive data on RTU have been obtained from the Health Insurance Review and Assessment Service (HIRA), which administers the national health insurance claims database. Several studies have previously described the clinical utilization of RT in Korea using HIRA data, covering periods from 2009 through 2021 [5-9]. Building upon this series, the present study analyzes HIRA claims data for 2022 and 2023 to describe the current clinical status of RT in Korea, including total patient numbers who received RT, demographic characteristics, cancer type distribution, RT modality utilization, and regional distribution.

Materials and Methods

We obtained and analyzed national claims data from the HIRA for the years 2022 and 2023 to identify the total annual volume of patients who received RT. To encompass all clinical indications for RT, patients across all International Classification of Diseases, 10th revision diagnostic codes were included if they had undergone procedures with corresponding RT-related codes. The customized cohort selection criteria and specific procedure codes utilized for RT identification are detailed in Tables 1 and 2.

Table 1.

The customized source population for this study

Table 2.

Procedure codes related to implementing radiation therapy

The overall RTU rate was defined as the number of cancer patients who received RT (restricted to C-code diagnoses) divided by the number of newly diagnosed cancer patients during the corresponding year, utilizing national cancer statistics from the Korea Central Cancer Registry [10,11]. The RTU rate for each specific cancer type was similarly calculated by dividing the cancer-specific RT patient volume by the corresponding cancer incidence recorded in the same year.

We evaluated the utilization profiles of specific advanced RT modalities, including intensity-modulated RT (IMRT), stereotactic RT (SRT), brachytherapy (BT), and proton therapy (PT), using the designated HIRA procedure codes (Table 2). The geographic distribution of RT delivery was analyzed based on the institutional location of the treating hospital. Regional cancer incidence data for comparison were obtained from the Korea Central Cancer Registry Annual Report for 2023 [11].

Data from 2009 to 2021 from our previous studies were included where necessary to show long-term changes [5-9]. These past findings were not reanalyzed but are simply presented alongside the current results for comparison.

Results

1. Total number of patients and sex distribution

The total number of patients who received RT in Korea reached 100,295 in 2022 and 104,100 in 2023 (Fig. 1). These figures represent year-over-year increases of 2.5% (from 97,840 in 2021) and 3.8% (from 100,295 in 2022), respectively, sustaining the consistent annual growth observed since 2019. In 2022, 45,327 patients (45.2%) were male and 54,968 (54.8%) were female; similarly, in 2023, 47,094 patients (45.2%) were male and 57,006 (54.8%) were female, demonstrating a stable sex ratio consistent with previous reports. Among the cohort treated in 2022, 89,570 patients presented with C-code (malignant neoplasm) diagnoses, 9,271 with D-code (carcinoma in situ or benign neoplasm) diagnoses, and 1,454 with other diagnoses. In 2023, these volumes were 92,345, 10,071, and 1,684, respectively (Fig. 2).

Fig. 1.

Total number and sex ratio of patients who received radiation therapy in Korea from 2019 to 2023.

Fig. 2.

Total number of patients who received radiation therapy in 2022 and 2023, stratified by International Classification of Diseases code in Korea.

2. Distribution and RTU rate by cancer diagnosis

The overall RTU rate, calculated by dividing the number of cancer patients who received RT by the annual cancer incidence, was 31.8% in 2022 and 32.0% in 2023 (Fig. 3). Patients with D-code and other non-malignant diagnoses were excluded from this denominator-matching calculation, although they collectively accounted for 10.7% and 11.3% of the total RT population in 2022 and 2023, respectively.

Fig. 3.

RTU rate among patients with cancer from 2019 to 2023. Cancer incidence data were obtained from annual reports of the Korea Central Cancer Registry. RT, radiation therapy; RTU, radiation therapy utilization.

Table 3 presents the detailed distribution of all RT patients stratified by diagnostic category. The five most common cancer types managed with RT were breast (C50), lung (C33–C34), prostate (C61), colorectal (C18–C20), and liver (C22) cancers in both years (Figs. 4, 5). Breast cancer constituted the largest single group, with 26,529 patients in 2022 and 27,395 in 2023, accounting for 29.6% and 29.7% of all C-code RT patients, respectively. The corresponding RTU rate for breast cancer was 89.8% in 2022 and 91.7% in 2023, representing the highest RTU rate among all major malignancies (Fig. 6). Notably, breast cancer alone accounted for nearly half of all female RT patients, representing 48.2% in 2022 and 47.9% in 2023 (Supplementary Table S1). Lung cancer was the second most frequent, comprising 14,581 patients in 2022 and 14,819 in 2023, with stable RTU rates of 45.1% and 45.0%, respectively. Of particular note, prostate cancer demonstrated a rapid upward trajectory, expanding from 8,374 patients in 2022 to 9,015 in 2023. The RTU rate for prostate cancer was 40.3% in 2022 and 39.8% in 2023, reflecting a substantial increase from 32.3% in 2017. Colorectal cancer ranked fourth, with 5,544 patients in 2022 and 5,533 in 2023, while the sub-analysis for rectosigmoid and rectal cancers (C19–C20) revealed an RTU rate of 28.5% in both years. Meanwhile, liver cancer ranked fifth, with 5,356 patients in 2022 and 5,447 in 2023, showing a continuous upward trend in RTU rates (35.9% in 2022 and 37.0% in 2023, up from 30.9% in 2019).

Table 3.

Distribution of patients who received radiation therapy according to diagnosis in 2022 and 2023 in Korea

Fig. 4.

Number of cancer patients who received radiation therapy for the five most common cancer types in Korea from 2019 to 2023.

Fig. 5.

Distribution of cancer patients who received radiation therapy (RT) by cancer type in Korea in 2023. Each segment represents the proportion of patients treated for the indicated cancer type among all cancer (C-code) patients who received RT.

Fig. 6.

Radiation therapy utilization (RTU) rates for nine major cancer types in Korea from 2019 to 2023. Panels represent breast (A), lung (B), prostate (C), rectosigmoid (D), liver (E), head and neck (F), uterine cervix (G), lymphoma (H), and esophageal cancer (I).

Among other malignancies, head and neck cancers (C00–C14, C30–C32, and C69; excluding thyroid cancer, C73) accounted for 5,101 patients in 2022 and 5,404 in 2023, yielding high RTU rates of 78.2% and 80.3%, respectively. Uterine cervical cancer (C53) also demonstrated robust utilization, with RTU rates of 76.2% (2,418 patients) in 2022 and 78.9% (2,481 patients) in 2023. Lymphomas (C81–C86, C88, and C96) comprised 2,389 and 2,424 patients, with stable RTU rates of 29.9% and 30.2%, respectively. Esophageal cancer (C15) was managed in 2,032 patients in 2022 and 2,141 patients in 2023, corresponding to RTU rates of 66.8% and 68.1%, respectively. Malignant brain tumors (C71) accounted for 1,927 patients in 2022 and 1,929 patients in 2023.

Table 4 outlines the top 10 broader cancer categories ranked by total RT patient volume. The overall distribution profiles between 2022 and 2023 remained remarkably consistent across most disease categories. However, the genitourinary cancer category exhibited a notable increase of approximately 0.4% in its relative proportion, a trend primarily driven by the continuous expansion of the prostate cancer cohort as detailed above.

Table 4.

Top 10 cancer categories treated with radiation therapy in Korea, 2022 and 2023

Among patients presenting with D-code diagnoses, breast carcinoma in situ (D05) was the most frequently managed entity, comprising 4,404 patients in 2022 and 4,816 in 2023. The corresponding RTU rate for breast carcinoma in situ remained remarkably stable at 68.5% in both years. Meningiomas (D32) accounted for 2,081 patients in 2022 and 2,246 in 2023, while other benign or borderline intracranial tumors (D33, D42, and D43) collectively totaled 1,638 and 1,828 patients, respectively.

3. Distribution by age group

Table 5 presents the detailed numbers and proportions of patients who received RT stratified by age group in 2022 and 2023. The proportion of patients aged 60 years and older demonstrated a continuous upward trajectory, collectively accounting for 59.6% of all RT patients in 2023. Patients aged 60–69 years formed the largest single age group in both years. Concurrently, the relative proportion of patients under 60 years underwent a gradual decline, reflecting both the growing absolute volume of elderly oncology patients and the rising incidence of age-related malignancies, such as prostate cancer. Table 6 outlines the five most common cancer types managed with RT within each age group for the year 2023. Malignancies of the brain and central nervous system remained the most prevalent among patients aged 0–19 years, breast cancer was predominant across the 20s through 60s age cohorts, while lung cancer emerged as the most frequent diagnosis in patients aged 70 years and older.

Table 5.

Total number and proportion of patients who received radiation therapy in Korea by age group

Table 6.

The five most common cancer types treated with radiation therapy by age group in 2023

4. RT by specific modality

Table 7 presents the number of patients treated with specific RT modalities from 2019 to 2023. The number of patients receiving IMRT has grown substantially, from 45,882 (52.6%) in 2019 to 72,406 (69.6%) in 2023. SRT also continued to increase, from 12,598 in 2019 to 15,703 in 2023. BT utilization remained relatively stable, ranging from 1,436 to 1,517 patients over the 5 years, while PT showed a slight increase from 1,274 to 1,495 patients. The number receiving other conventional modalities (2D and 3D conformal RT) correspondingly decreased from 26,068 (29.9%) in 2019 to 13,043 (12.5%) in 2023.

Table 7.

The number of patients according to specific radiation therapy modalities between 2019 and 2023

5. Regional distribution of RT utilization

Fig. 7 illustrates the regional distribution of RT patients and BT cases, evaluated in comparison with the regional cancer incidence. Seoul, which accounted for only 18.1% of the national cancer incidence in 2023 (52,185 of 288,613 newly diagnosed patients), delivered 45.5% of all RT services nationwide (47,320 of 104,100 patients). The broader capital metropolitan area, comprising Seoul, Gyeonggi, and Incheon, represented 47.6% of the national cancer incidence yet provided 67.1% of all national RT services (69,865 patients). In sharp contrast, most provincial regions delivered RT volumes that fell substantially short of their local cancer incidence, indicating that a significant proportion of regional patients migrated outside their residential areas to receive treatment. For BT specifically, Seoul alone accounted for 53.0% (770 of 1,453 cases) of all national BT cases in 2023.

Fig. 7.

Regional distribution of cancer incidence, radiation therapy utilization, and brachytherapy utilization in Korea in 2023.

Discussion and Conclusion

The present study provides a comprehensive analysis of RTU in Korea for 2022 and 2023, continuing the series of national RT statistics based on HIRA claims data. Notably, the total number of patients treated with RT in Korea reached 100,295 in 2022 and further expanded to 104,100 in 2023, marking the first time the annual patient volume has exceeded 100,000. Concurrently, the RTU rate for cancer patients has consistently remained above the 30% baseline for 7 consecutive years (Supplementary Fig. S1). Although the RTU rate showed a transient decline between 2020 and 2021, this fluctuation was primarily attributable to the coronavirus disease 2019 pandemic. Temporary limitations on healthcare access in 2020 reduced the recorded cancer incidence, which artificially elevated that year's RTU rate. This was subsequently followed by a sharp rebound in cancer diagnoses in 2021 as deferred cases were registered [12]. Despite these temporary fluctuations in rates, the absolute number of patients receiving RT steadily increased throughout the pandemic, demonstrating the robust resilience of RT delivery in Korea.

Korea’s actual RTU rate of 32.0% in 2023 is lower than the evidence-based optimal range of approximately 42% to 52% reported in previous global studies [13-16]. However, this apparent gap must be interpreted in light of Korea's unique cancer epidemiology. Driven by a comprehensive national cancer screening program, Korea exhibits a high proportion of early-stage, screen-detected malignancies for which RT is not routinely indicated [11,17]. In particular, thyroid and stomach cancers accounted for 12.3% and 10.0% of all incident cancers in Korea in 2023, respectively. Because these two malignancies exhibit a substantially higher incidence in Korea than the global average and are managed primarily through surgical resection, they contribute minimally to RT utilization, thereby diluting the overall RTU rate. Hence, whether Korea’s RTU rate is truly suboptimal or appropriate given its specific case mix requires further investigation. This should involve cancer-specific and stage-specific benchmarks rather than a simple comparison of crude aggregate rates with the optimal estimates derived from previously published literature.

Breast cancer recorded the largest absolute increase in RT patient numbers over the past 5 years, growing from 22,499 patients in 2019 to 27,395 in 2023, which represents a net gain of approximately 4,900 patients. The sustained RTU rate above 90% underscores the essential role of RT in breast cancer management in Korea, particularly in the context of breast-conserving surgery. Furthermore, when expanding the scope to include breast carcinoma in situ (D05), patients treated for breast diseases accounted for more than 30% of the entire national RT population, comprising 30.8% (30,933/100,295) in 2022 and 30.9% (32,211/104,100) in 2023. This substantial volume implies that more than half of all female patients undergoing RT are being treated for breast-related diagnoses.

Prostate cancer has shown the most remarkable growth in RT utilization, with the annual patient volume more than doubling compared to 2017 and driving the disease from fifth to third place among all cancer types receiving RT (Supplementary Fig. S2). This trend reflects both the rapidly increasing incidence of prostate cancer in Korea’s aging population and the expanded adoption of RT as a definitive treatment option, which has been supported by technological advancements such as IMRT and stereotactic body RT (SBRT). Crucially, prostate cancer became the most commonly diagnosed cancer in Korean men for the first time in 2023, driving this volume [4]. Notably, however, the RTU rate for prostate cancer remained remarkably plateaued at approximately 40% during the 2022–2023 analysis period, despite this substantial surge in absolute patient numbers. This plateau in the RTU rate indicates that the rapidly expanding incidence of prostate cancer has proportionally absorbed the increase in RT uptake, meaning that the fraction of prostate cancer patients receiving RT has not substantially changed. As prostate cancer incidence is projected to rise further in Korea’s super-aging society, sustained efforts to expand RT capacity and optimize clinical resources for this specific population will be critical.

The decrease in the RTU rate for rectosigmoid cancer from 37.6% (2020) to 30.4% (2021) is attributable to the reclassification of colorectal neuroendocrine tumors (International Classification of Diseases for Oncology, 3rd edition: 8152 and 8240) as malignant neoplasms in the Korean cancer registry beginning in 2021 [12]. This change expanded the registration scope and increased the recorded incidence of rectosigmoid cancer, raising the denominator by 28.2% (from 11,747 to 15,065 cases) without a corresponding change in clinical practice. The absolute number of rectosigmoid cancer patients receiving RT remained stable at approximately 4,400–4,600 per year throughout 2019–2023. The apparent decline therefore reflects a statistical discontinuity in the denominator rather than a true reduction in RT utilization, and the RTU rate has since remained stable at approximately 28%–30%.

Liver cancer stands in contrast to other cancer types. While the number of newly diagnosed cases has shown a gradual declining trend, the absolute number of patients receiving RT has steadily increased over the same period, leading to a consistent rise in the RTU rate. This upward trend likely reflects the evolving clinical paradigm in Korea, where RT is increasingly integrated into multidisciplinary management for hepatocellular carcinoma, such as in combination with transarterial chemoembolization or as an increasingly utilized approach for advanced tumors with portal vein tumor thrombosis. This expanded clinical role of RT has been further facilitated by accumulating evidence supporting its efficacy and the subsequent expansion of national health insurance coverage for high-precision modalities, including SBRT and PT.

The transition from conventional RT techniques to IMRT has accelerated considerably. Over the analyzed period, IMRT has emerged as the dominant treatment modality nationwide, a shift driven by both the expanded national health insurance coverage for IMRT and the widespread adoption of modern linear accelerators capable of advanced delivery. Correspondingly, the proportion of conventional 2D RT or 3D conformal RT has markedly declined, reflecting a broader clinical migration toward high-precision RT. This structural shift aligns with global trends and underscores a substantial improvement in the overall quality and safety of cancer treatment in Korea.

The persistent regional concentration of RT services in Seoul remains a major structural challenge in the national healthcare system. As demonstrated in our results, Seoul provides nearly half of all national RT services despite accounting for less than one-fifth of the total cancer incidence, highlighting a stark imbalance between RT delivery and the geographic distribution of disease burden. This pronounced centralization reflects a scenario where provincial regions provide RT volumes that fall considerably short of their own regional cancer incidence, suggesting substantial outward migration of local patients to Seoul-based tertiary centers.

This geographic imbalance becomes even more critical when focusing on BT. BT is highly labor-intensive and demands substantial operational expenditures, including specialized equipment maintenance and regular radioactive source replacement, which frequently impose a considerable financial and operational burden on regional institutions. Despite a stable national demand for BT, the number of institutions actively providing this service has steadily diminished nationwide. Indeed, our data demonstrate this decline, with the total number of active BT-performing institutions dropping from 36 in 2019 to 28 in 2022 (Supplementary Table S2). This overall reduction in active providers has intensified the structural challenges in maintaining accessible regional infrastructure. As a result, several individual administrative regions and metropolitan areas outside of Seoul now face a critical shortage of active BT facilities, compelling patients in these underserved areas to travel long distances to the capital for essential care and driving Seoul's share of national BT cases to exceed 50%. This progressive erosion of BT infrastructure poses a direct threat to the quality of oncological care. BT is an irreplaceable, curative-intent component of the standard treatment pathway, particularly for locally advanced cervical cancer, where its omission is strongly linked to inferior local control and overall survival [18-20]. To address this widening geographic gap and prevent further contraction of essential cancer care, comprehensive and sustainable policy interventions are warranted. These should include the financial restructuring of national insurance fees to better reflect actual operational expenses, targeted regional infrastructure subsidies, and strategic workforce development incentives tailored for non-metropolitan areas.

The present study has several limitations inherent to HIRA-based analyses. First, the RT patient count includes both newly diagnosed patients and those with recurrent disease undergoing subsequent RT courses, potentially leading to an overestimation of the true RTU rate. Second, uninsured patients and foreign nationals covered outside the national health insurance system are excluded from the HIRA data. Third, this database analysis does not differentiate between RT intents (curative vs. palliative) or specific fractionation schemes. Of note, starting from 2024, a revision of the national health insurance reimbursement structure for RT in Korea has introduced distinct billing codes for hypofractionated RT regimens. This change is expected to enable systematic analyses of hypofractionation adoption rates in future HIRA-based studies. This will be particularly informative for breast and prostate cancers—two malignancies in which hypofractionated RT has been established as the standard of care based on high-level evidence and where current practice patterns in Korea are undergoing rapid changes [21-25]. Quantifying these fractionation trends within the Korean national context, and examining their impact on RTU rates, treatment capacity, and patient outcomes, represents an important direction for future research in this series. Despite these limitations, the HIRA database provides the most comprehensive, national-level data on RTU in Korea.

In conclusion, the number of patients treated with RT in Korea has continuously increased, reaching 100,295 in 2022 and 104,100 in 2023, marking the first time the annual patient volume has exceeded 100,000. The RTU rate for cancer patients was 31.8% in 2022 and 32.0% in 2023, remaining above 30% for 7 consecutive years. IMRT has become the dominant RT modality, accounting for 69.6% of all RT cases in 2023. Notably, prostate cancer has shown the most rapid growth in RT utilization. Concurrently, the regional concentration of RT services in Seoul remains a persistent structural challenge. These findings underscore the ongoing expansion of RTU in Korea and highlight the need for continued monitoring and an equitable nationwide distribution of RT resources.

Supplementary Materials

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