Atkins KM, et al. - In this retrospective study of consecutive locally advanced non–small cell lung cancer (NSCLC) patients (n=748) who received thoracic radiotherapy, researchers intended to determine if major adverse cardiac events (MACE) and all-cause mortality (ACM) are predicted by cardiac radiation dose. A significantly increased risk of MACE and ACM was reported in relation to mean radiation dose delivered to the heart (mean heart dose). A significantly increased risk of ACM was found in coronary heart disease (CHD)-negative patients, but not among CHD-positive patients, in relation to mean heart dose (≥10 Gy vs <10 Gy). For MACE and ACM, cardiac radiation dose exposure was identified as a modifiable cardiac risk factor in locally advanced NSCLC patients, despite the competing risk of cancer-specific mortality. Therefore, more stringent avoidance of high cardiac radiotherapy dose as well as early detection and management of cardiovascular events is required.