Graveyard shifts.

We’ve all seen the increasing amount of data describing the detrimental effect of moderate heart radiation for patients with lung and esophageal cancers. An interesting thing to remember, though, is that this data is based on the original treatment plan—it doesn't account for the daily variation in patient setup and organ location. This study evaluated the image-guided shifts of over 750 patients with non-small cell lung cancer (NSCLC) and over 150 patients with esophageal cancer to discover that recurrent corrections in patient positions moving the heart closer to the target were associated with worse survival. This association was linear such that every additional millimeter shifting the heart closer to the target increased the risk of death. TBL: Heart dosimetry barely passing constraints? You may wanna cover your eyes during daily image review. | Johnson, Int J Radiat Oncol Biol Phys 2018