Spatial mapping of cardiac dose-survival associations in oesophageal radiotherapy
In brief
Keeping cardiac dose below 44 Gy improves 12-month survival in esophageal cancer radiotherapy
In a study of 452 patients treated curatively for middle or lower oesophageal cancer, receiving a maximum dose under 43.5 Gy to a specific cardiac region was linked to longer median survival at one year, and this dose remained an independent predictor after adjusting for other factors. The result suggests planning to spare this heart area could boost outcomes, but prospective validation is needed.
- Journal
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Q1)
- Published
- 4 September 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Tom Marchant, Ganesh Radhakrishna, Hamid Sheikh, Corinne Faivre-Finn, Gareth Price, Alan McWilliam
- PMID
- 42697274
- DOI
- 10.1016/j.radonc.2026.111770
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 8 September 2026): Spatial cardiac dose-survival analysis, esophageal RT
Abstract
PURPOSE: To investigate spatial associations between cardiac radiation dose and survival following radiotherapy for oesophageal cancer, and to assess whether a previously defined Cardiac Avoidance Area (CAA) from lung radiotherapy is relevant in this patient population. MATERIALS AND METHODS: Patients treated with curative-intent radiotherapy for middle or lower oesophageal cancer between 2009 and 2024 were identified from a large institutional database. Planning CT images and dose distributions were deformably registered to a common reference anatomy for voxel-based analysis. Dose-survival associations were assessed voxel-wise by comparing dose between patients alive and deceased at 12 months, with permutation testing for multiple comparisons. Dose to the CAA was quantified, and survival was evaluated using Kaplan-Meier analysis and multivariable Cox regression including clinical covariates. RESULTS: A total of 452 patients were included. Voxel-based analysis identified a spatially localised heart region where higher radiation dose was significantly associated with poorer 12-month survival, exceeding the 99th percentile of permutation-derived significance. This region partially overlapped with the lung-derived CAA and the left atrium. A maximum CAA dose threshold of 43.5 Gy produced significant survival stratification, with improved median survival in patients receiving lower doses. Maximum CAA dose remained an independent predictor of survival on multivariable analysis. CONCLUSION: Image-based data mining identified a radiosensitive cardiac region associated with survival after oesophageal radiotherapy, overlapping the established CAA from lung cancer. These findings support the relevance of spatially defined cardiac dose metrics and suggest a potential role for targeted cardiac avoidance in oesophageal radiotherapy planning.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.