Brief Report of a New Anatomical Region at Risk in Thoracic Radiotherapy: From Discovery to Implementation

Area of Science:

• Cardiology
• Radiation Oncology
• Medical Imaging

Background:

• Increasing radiotherapy doses to cardiac structures correlates with adverse cardiac events and mortality.
• Prior research indicates a dose-response relationship for heart base structures.
• Image-based data mining has informed the identification of critical cardiac regions.

Purpose of the Study:

• To define a novel cardiac anatomical region at risk during radiotherapy.
• To establish a consensus-based definition for this critical cardiac area.
• To facilitate the clinical implementation of cardiac radiation protection strategies.

Main Methods:

• Consensus opinion derived from image-based data-mining studies.
• Definition of a specific cardiac anatomical region for avoidance.
• Development of a contouring atlas for standardized implementation.

Main Results:

• A new cardiac avoidance area has been defined.
• This area includes the superior vena cava, right atrium, aortic root, left main coronary artery, and proximal left anterior descending and right coronary arteries.
• A contouring atlas is provided to aid in delineating this region.

Conclusions:

• The defined cardiac avoidance area is crucial for minimizing radiation-induced heart toxicity.
• Standardized contouring using the provided atlas can improve patient safety in radiotherapy.
• This approach aims to reduce cardiac events and improve long-term survival for cancer patients.