{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:51:52Z","timestamp":1791265912706,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100008005","name":"Yonsei University College of Medicine","doi-asserted-by":"publisher","award":["2026\u201032\u20100070"],"award-info":[{"award-number":["2026\u201032\u20100070"]}],"id":[{"id":"10.13039\/501100008005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008005","name":"Yonsei University College of Medicine","doi-asserted-by":"publisher","award":["6\u20102026\u20100069"],"award-info":[{"award-number":["6\u20102026\u20100069"]}],"id":[{"id":"10.13039\/501100008005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["RS\u20102023\u201300279682"],"award-info":[{"award-number":["RS\u20102023\u201300279682"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Soft tissue sarcoma (STS) is a rare malignancy with increasing utilization of advanced radiotherapy (RT). We evaluated nationwide transitions in RT patterns and clinical outcomes for STS in South Korea, focusing on the impact of national healthcare policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Utilizing the National Health Insurance Service database (2005\u20132023), we identified 52,245 patients with STS. Temporal trends in RT modalities (3D\u2010conformal RT [3D\u2010CRT] vs. intensity\u2010modulated RT [IMRT]) and fractions per course were analyzed using joinpoint regression with a pre\u2010specified breakpoint at 2014. Survival analysis was performed for 45,465 patients using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The annual incidence of STS increased from 2338 to 3066 cases. A definitive shift toward IMRT occurred following the 2015 insurance expansion; by 2023, IMRT utilization reached 17.5%, while 3D\u2010CRT declined to 0.3%. A sharp increase in mean fraction count was identified in 2012, with mean fractions rising from &lt;\u20098 to &gt;\u200916, indicating a marked shift in fractionation practice. In survival analysis, RT groups showed higher hazard ratios (HRs) for mortality (3D\u2010CRT: 1.24; IMRT: 1.32), reflecting confounding by indication where RT was reserved for high\u2010risk patients. However, in the non\u2010surgery subgroup, IMRT was associated with a lower mortality risk than 3D\u2010CRT (HR 1.20 vs. 1.25). Similarly, in pediatric patients, IMRT demonstrated a lower HR compared with 3D\u2010CRT (3.35 vs. 4.19).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RT for STS in Korea has transitioned to an IMRT\u2010centered paradigm, catalyzed by supportive insurance policies. In non\u2010surgery and pediatric cases, IMRT showed a lower HR than 3D\u2010CRT, though this hypothesis\u2010generating finding does not establish a survival benefit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72274","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:23:57Z","timestamp":1790252637000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two\u2010Decade Trends in Radiotherapy Patterns and Clinical Outcomes for Soft Tissue Sarcoma: A Nationwide Study in South Korea (2005\u20132023)"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5205-3775","authenticated-orcid":false,"given":"Tae Hyung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Yongin Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System  Yongin Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1007-1633","authenticated-orcid":false,"given":"Jun\u2010Hyuk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Nowon Eulji Medical Center, Eulji University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungtae","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Physiology Hanyang University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuntak","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Physiology Hanyang University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4083-6414","authenticated-orcid":false,"given":"Seo Hee","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute Yonsei University College of Medicine, Yonsei University Health System  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2106-6856","authenticated-orcid":false,"given":"Hong","family":"In Yoon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute Yonsei University College of Medicine, Yonsei University Health System  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp415"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20073"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2018.476"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2021.07.006"},{"key":"e_1_2_10_6_1","unstructured":"N.C.C. Network \u201cNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Soft Tissue Sarcoma. Version 3.2026 \u201d(2026) https:\/\/www.nccn.org."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S337606"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2021.04.005"},{"key":"e_1_2_10_9_1","volume-title":"Status of Medical Benefit Coverage by the National Health Insurance Service","author":"Ministry of Health and Welfare","year":"2025"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2018.33.e67"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyad106"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23452"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11365"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.9452"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70098-6"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.58.5828"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.72274","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.72274","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.72274","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:52:04Z","timestamp":1791262324000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.72274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/cam4.72274"],"URL":"https:\/\/doi.org\/10.1002\/cam4.72274","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-04-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72274"}}