Radiation therapy (RT) is a cornerstone in the management of locally advanced lung cancer, including stage III non-small cell lung cancer. Advances in RT technology, such as imageguided radiotherapy, respiratory motion management, and intensity-modulated radiation therapy, have allowed for a more precise delivery of thoracic RT. However, the potential late effects on normal tissues remain of concern. Particularly, cardiac toxicity has been discussed as the likely reason for worse survival in the high-dose arm of the RTOG 0617 trial, which randomly assigned patients to chemoradiotherapy (CRT) with either 60 Gy or 74 Gy. 1 Both heart dose and baseline cardiac risk have been associated with cardiac events after high-dose thoracic RT, and studies are now evaluating the impact of radiation dose on sensitive structures, such as the base of the heart. 2-4 However, despite advances in our understanding of these issues, cardiac risk assessment during treatment planning for lung cancer has remained largely simplistic, often focusing on dosimetric values (eg, mean heart dose), which are of limited predictive value in patients undergoing RT or CRT for lung cancer. 5 ACCOMPANYING CONTENT