Incidence and Clinical Utilization of Radiotherapy of Childhood Tumors in South Korea Using National Health Insurance Sharing Service Data

Abstract

Objectives

This study aimed to evaluate the clinical utilization of radiotherapy for childhood tumors in South Korea using National Health Insurance Sharing Service (NHISS) data.

Methods

Children aged 19 or younger diagnosed with childhood tumors from 2003 to 2020 were identified in the NHISS data using the International Classification of Disease 10 (ICD-10) codes C and D. Data from 2003 and 2004 were excluded to adjust for the washout period.

Results

Between 2005 and 2020, 36,152 patients were diagnosed with childhood tumors. The distribution over four-year intervals was as follows: 13,716 (0.11% of total population) in the first quadrennial period (2005-2008), 8,846 (0.08%) in the second (2009-2012), 6,893 (0.07%) in the third (2013-2016), and 6,697 (0.07%) in the fourth (2017-2020). Regarding radiotherapy, of the total patients aged 19 or younger, 5.6% underwent treatment in the first period, 10.0% in the second, 11.7% in the third, and 11.7% in the fourth. Among those treated with radiotherapy, 2-dimensional (2D), 3D-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and proton therapy were used in 110 (14.3%), 608 (79.1%), 34 (4.4%) and 8 (1.0%) cases in the first quadrennial period, 50 (5.7%), 604 (68.3%), 170 (19.2%) and 53 (6.0%) cases in the second, 18 (2.2%), 310 (38.4%), 364 (45.0%) and 116 (14.4%) cases in the third, and 4 (0.6%), 83 (12.7%), 405 (61.8%) and 162 (24.7%) cases in the fourth, respectively. The most common tumors treated with radiotherapy, in order of prevalence, were brain (C71; e.g., ependymoma, n=986), benign neoplasm of central nervous system (D33, D43; e.g., craniopharyngioma, n=764), primary bone and cartilage (C40-41; e.g., osteosarcoma, n=286), non-Hodgkin's lymphoma (C83.7 and C85; e.g., b-cell lymphoma, n=200), soft tissue (C46 and C49.9; e.g., rhabdomyosarcoma, n=186), endocrine (C74-75; e.g., adrenal gland tumor, n=164), Hodgkin lymphoma (C81, n=123), and nasopharyngeal cancer (C11.9, n=92).

Conclusions

Despite the declining birth rate, the overall incidence rate of childhood tumors remains steady at approximately 0.07% of the total population. Radiotherapy utilization rate showed an increasing trend according to the more recent quadrennial period. This trend may be associated with the introduction of more advanced radiotherapy techniques with extended national health insurance coverage. This tendency was repeatedly manifested in the subset of patients with CNS tumors.