By now we all know radiation dose to the heart can have a meaningful impact on outcomes for patients treated for thoracic malignancies. Previous studies using voxel based analysis of heart dose have identified a region in the central base of the heart strongly associated with adverse cardiac effects after radiation for lung cancer. This study took a similar approach to analyze cardiac dose for 452 patients who had received definitive radiation for cancer of the middle or lower esophagus. As before, their analysis homed in on a region in the base of the heart overlapping with the previously derived Cardiac Avoidance Area (CAA) and the left atrium. They identified a threshold maximum dose of 43.5 Gy to this region that stratified patients at low or high risk of worse survival outcomes. For patients receiving thoracic radiation for lung cancer or esophageal cancer, minimizing dose to this empirically derived, dose sensitive region in the base of the heart could reduce the risk of adverse cardiac effects. | Marchant, Radiother Oncol 2026
