RadOnc Smart Review

This is Episode 15A: Perineural Invasion Tracking and Skull Base Extension. The pathology report lands on your desk: “Extensive perineural invasion involving a named nerve measuring zero-point-three millimeters in diameter. Inferior alveolar nerve identified at the deep margin.”Now what? Do you treat the tumor bed and call it a day? Do you track the nerve all the way to the skull base? How far is...

This is Episode 14C: Definitive Radiation and Brachytherapy for Oral Cavity Cancer. Throughout this oral cavity series, we’ve emphasized one principle above all: oral cavity cancer is a surgical disease. Surgery first. Radiation in the adjuvant setting. But what happens when surgery isn’t an option?

This is Episode fourteen B: Planning with Reconstruction - Flaps, Hardware, and the O.R.N. Trade-Off. In Episode eleven B, we built your planning vocabulary: simulation, volumes, nodal levels, and O.A.R. priorities. But that episode assumed a straightforward post-operative bed. What happens when surgery was more complex? When the patient has a fibular free flap reconstructing the mandible? When th...

In Episode eleven A, we established that oral cavity cancer is a surgical disease. We learned the anatomy, the staging, and why surgery wins. But here's the thing: when pathology comes back with adverse features, you become the treating physician. And that means you need to know how to plan. This episode builds your technical vocabulary. We're going to cover how to simulate an oral cavity patient,...

This is Episode fourteen: Oral Cavity Four — Mandible, Reconstruction, and Bone Invasion Pitfalls. In the previous three episodes, we covered oral cavity anatomy, surgical management, the neck decision, and adjuvant therapy principles. Now we need to tackle what happens when the mandible is in play—and it often is. The mandible is the elephant in the room for oral cavity radiation. Floor of mouth...

This is Episode thirteen: Oral Cavity Three — PORT versus Post-op Chemo-RT: The "Big Two."In the last two episodes, we established that oral cavity cancer is a surgical disease and that the clinically node-negative neck requires elective treatment when depth of invasion exceeds three to four millimeters. Now the surgery is done. The pathology report is in your hands. The question becomes: what adj...

This is Episode twelve: Oral Cavity Two — The Clinically Node-Negative Neck: Elective Dissection, Not Watchful Waiting. In Episode Eleven, we established that oral cavity cancer is a surgical disease and that depth of invasion drives staging and management. We introduced the concept of elective neck dissection for the clinically negative neck. Now we're going to go deep on the evidence. The cN0 ne...

This is Episode eleven: Oral Cavity One — Subsites, Depth of Invasion, and Why Surgery Usually Wins. Over the next four episodes, we're going to master oral cavity cancer from the perspective of the radiation oncologist preparing for boards. And I want to be clear about something right up front: oral cavity is a surgical disease. Unlike oropharynx, where definitive chemoradiation is standard, oral...

This is Episode 10: Foundations IX — Planning Workshop: IMRT, VMAT, Protons, and OAR Priorities. We’ve arrived at the “dark room” episode. Up to now, you’ve made clinical decisions: diagnosis, stage, intent, dose, and fractionation. Now you’re at the console, staring at a CT and a dose cloud, and the boards are essentially asking: “Do you know what matters, and can you keep the patient safe?”

This is Episode 9: Foundations VIII — Supportive Care II: Swallow, Aspiration, Trismus, and Osteoradionecrosis. Last episode was: “Don’t lose the patient during treatment.”This episode is: “Don’t ruin the next thirty years of their life.”Head and neck survivorship is different. We’re curing more patients, younger patients, and we’re curing them with treatments that permanently reshape function. La...

This is Episode 8: Foundations VII — Supportive Care I: Dental, Nutrition, and Mucositis. We have spent the last seven episodes talking about how to kill the cancer. Today, we talk about how to keep the patient alive while we do it. On oral boards, supportive care is the great differentiator. A candidate who can recite fractionation trials but cannot explain when to pull a tooth, when to place a P...

This is Episode 7: Foundations VI — Systemic Therapy With RT: Cisplatin, Cetuximab, and Alternatives. We’ve built the scaffolding: anatomy, staging, and fractionation. Now we add the lever that most reliably increases cure rates in locally advanced head and neck cancer: concurrent systemic therapy. And here’s the board-relevant truth: examiners don’t just test whether you know that “chemo helps.”...

This is Episode 6: Foundations V — Fractionation and Time: Why We Don’t Treat Head and Neck Like Prostate. In prostate cancer, a week off for a holiday can be inconvenient, but the tumor biology barely flinches. In head and neck squamous cell carcinoma, a week off is not “just a delay.” It is a biological advantage handed to the tumor. Today is the Time Factor episode: overall treatment time, acce...

This is Episode 5: Foundations IV — AJCC Staging That Actually Changes Management. Most residents treat staging as paperwork—something you fill out after you’ve already decided the plan. That’s backward. In AJCC Eighth Edition, staging is a decoder ring: it tells you which disease biology you’re dealing with, what patterns of failure to respect, and which high-risk variables will force treatment i...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 4: Unknown Primary — The Neck Mass Without a Mucosal Home. In the last episode, we talked about the workup. We scoped, we scanned, and we biopsied. Most of the time, that process finds the culprit — a small tonsil cancer hiding in crypts or a base of tongue tumor you could miss on casual inspection. But sometimes, you do...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 3: Foundations III — Workup Masterclass: Scope, PET, Pan endo, and Biomarkers. Today is about the discipline of diagnosis. On oral boards, there is a specific way to fail a head and neck case before you ever draw a contour: you jump to treatment before you have established the diagnosis and stage. That signals immaturity....

This is Episode 2: Foundations II — Cranial Nerves, PNI Highways, and the Skull Base.**Last episode, we mapped lymphatics. Today, we map nerves. Because in head and neck oncology, **perineural invasion is not just a pathology word. It is geography.** It is a route problem. When tumor gets into a nerve, it can travel **from a peripheral skin site or gland to the skull base foramina**, and from ther...

This is Episode 1: Foundations I — Neck Levels and Spaces That Change Volumes. We are starting this season with anatomy because in head and neck oncology, anatomy is destiny. If you do not understand the drainage pathways, you cannot draw the target. And if you cannot draw the target, you cannot cure the patient—or worse, you cure them but leave them with avoidable, life-altering toxicity. Today,...

This is Episode 18: *Mock Oral Boards 2 – Vulvar, Vaginal, and Complex Recurrence Cases*. This is our **final episode in the GYN series**. In the **next series, we’ll move on to Breast cancer** and build a new mock oral framework there.**Examiner:** In Episode 17, we focused on cervical and endometrial cancer fundamentals and brachytherapy technique. Today we escalate to the “exam-separating” scen...

Today, we're not just reviewing content; we're practicing the *performance* of the oral boards. I will act as your examiner, providing board-style prompts for eight comprehensive cases, each with a contrasting twist. When you hear the pause, answer out loud, practicing a crisp, structured, and confident response. After each pause, I’ll give you a model answer—a polished performance script—followed...

Welcome back to Rad Onc Smart Review, GYN Series. This is Episode 16: GYN Brachytherapy — The Oral Boards Performance Guide. Today is a mock oral. I’ll ask; you answer. Then I’ll give teaching pearls. Focus on applicator selection, polished procedural scripts, hybrid escalation, plan read-outs, troubleshooting, and complications. Pause after each question to formulate your answer.

Ovarian cancer is dominated by surgery and systemic therapy. As radiation oncologists, we’re expert consultants who step in at critical junctures: to clarify staging and risk, to advise on maintenance systemic strategies that shape recurrence patterns, and to deliver highly conformal radiation for palliation or carefully selected oligometastatic disease. Today we’ll cover surgical staging and cyto...

Today we will master primary vaginal cancer from first principles to planning. We will start with epidemiology, pathophysiology, and the anatomy that dictates nodal targets. We will explain why definitive radiation is the backbone of curative therapy for most stages. Then we will design a complete plan that combines pelvic EBRT with a brachytherapy boost, including when to choose an interstitial i...

Last time we built the algorithm for early vulvar cancer—who needs nodes, how sentinel mapping changes the plan, and when to radiate the vulvar bed and groins. Today we turn to the hard one: locally advanced, unresectable disease. We’ll start by defining “unresectable,” walk through the neoadjuvant chemoradiation evidence, and then do a planning workshop you can take straight to clinic: how to con...

This is Episode twelve: Vulvar Cancer Part one—Foundations and evidence for surgery and adjuvant radiation. Today we build from first principles—epidemiology, pathophysiology, anatomy, workup, and staging—and then walk the decision tree for surgery, nodes, and radiation using four anchor studies: the depth-of-invasion rule from the GOG era, the GROINSS-V pathway for sentinel nodes, the Heaps margi...