RadOnc Smart Review

Episode 19D: Benign P3d: Rare Benign Rapid Review. Needs editing

This is Episode 19c: Benign P3c: Trigeminal Neuralgia – SRS for Functional Pain. Needs editing

This is Episode 19b: Benign P3b: AVM Part 2 - SRS Technique, Doses & Toxicity. Needs editing

This is Episode 19a, the first in our new two-part series on a fascinating and challenging benign condition: Arteriovenous Malformations, or AVMs. To build a foundational understanding of arteriovenous malformations (AVMs) by covering their biology and risk factors, applying the Spetzler-Martin scale to assess surgical risk, calculating annual hemorrhage risk, and critically dissecting the controv...

In our last episode, we mastered the management of non-functioning pituitary adenomas, where the primary goal of radiation is long-term tumor control. Today, we tackle the more complex world of functional, or secreting, pituitary adenomas. Here, the clinical challenge is entirely different. Our goal is not just to control the size of the tumor, but to achieve biochemical control—to shut down the h...

In our last two episodes, we mastered the management of vestibular schwannomas. Today, we shift our focus to another common sellar region tumor: the pituitary adenoma. While often discovered incidentally, these tumors can cause significant morbidity through mass effect. In this episode, we will focus specifically on non-functioning pituitary adenomas, covering their comprehensive workup, surgical...

In our last episode, we established the foundational framework for managing vestibular schwannomas. We worked up our patient, a 55-year-old man with a Koos Grade II tumor and serviceable hearing, and after reviewing the options, decided that stereotactic radiosurgery offered him the best balance of tumor control and functional preservation. Today, we take him to the treatment planning system. This...

Today we're tackling one of the most common non-malignant brain tumors you will treat: the vestibular schwannoma, also known as an acoustic neuroma. While histologically benign, these tumors can cause significant, life-altering morbidity by affecting hearing, balance, and facial function. The management is a masterclass in shared decision-making, balancing excellent tumor control rates against the...

This is Episode 17b: Non-Glioma Part 2: Atypical & Anaplastic Meningiomas & Future Directions. In Episode 17a, we built the essential foundation for understanding meningiomas, covering their epidemiology, detailed WHO grading, and the management of WHO Grade I tumors. Today, we confront the more challenging and clinically critical aspects: the complex management of Atypical (Grade II) and...

This is Episode 17a: Non-Glioma Part 1: Meningioma Foundations & Grade I Management. While gliomas often take the spotlight, the single most common primary intracranial tumor you will encounter is the meningioma. But don't let its often-benign histology fool you; the management of meningiomas is deceptively complex, nuanced, and surprisingly lacking in high-level randomized evidence. Today, we...

In our last episode, we laid the complete foundation for managing spinal metastases. Today, we transition from the broad strokes of conventional palliation to the high-precision, high-impact world of Stereotactic Body Radiation Therapy, or SBRT. This episode is a practical workshop. We will cover who to treat with SBRT, a deep dive into the conflicting evidence, how to delineate targets with a ste...

In Episode 15a, we covered the comprehensive workup for a patient with suspected spinal metastases, from distinguishing pain types to detailed imaging interpretation and initial supportive care. Today, we move to the definitive decisions. We will master the assessment of spinal stability using the SINS score, delineate the Bilsky scale for grading cord compression, and define the evidence-based ma...

This is Episode 15a, the first in our new two-part foundational series on Spinal Metastases. Today's episode is titled: "Spine Mets Part 1: Anatomy & Initial Workup."Metastatic disease to the spine is one of the most common and challenging scenarios we face. It can cause debilitating pain, catastrophic neurologic injury, and profoundly impact quality of life. Correct management requires a rapi...

This is our mock oral boards for lower GI malignancies. I will present two comprehensive rectal cancer cases, walking you through each one from initial presentation all the way through treatment and follow-up. For each section, I want you to pause and formulate your own structured response before I walk you through the model answer and a key teaching pearl. The goal is to think like an attending a...

Over the last several episodes, we've systematically broken down the evidence that defines modern GI oncology. Today, we put that knowledge to the test. This episode is a mock oral board examination. I will present five comprehensive case blocks, covering Esophageal, Gastric, Pancreatic, Hepatobiliary, and Hepatocellular cancers. For each, I will present a clinical scenario and then pose a series...

This episode is a mock oral boards session. I will present three distinct, challenging clinical scenarios. For each case, we will walk through the entire management process, from initial presentation all the way through treatment and follow-up, to sharpen your clinical decision-making.

Over the past decade, the landscape of systemic therapy has been transformed by the arrival of immunotherapy and highly effective targeted agents. Many of these drugs have significant intracranial activity, creating a new and complex challenge for the radiation oncologist: how do we sequence our treatments? The old paradigm of "radiation first" is no longer always correct. Today, we will provide a...

Today, we address the frontiers of SRS. First, we'll ask: can we treat more than four metastases? Second, how do we safely and effectively treat large metastases that are too big for a single high dose of radiation? And finally, we will tackle the most common and challenging complication of SRS: how to differentiate radiation necrosis from tumor progression.

Today, we will conduct a practical workshop on postoperative stereotactic radiosurgery. We'll dissect the two landmark trials that define this practice, learn how to properly delineate a post-operative target volume, and discuss the dreaded complication of nodular leptomeningeal disease.

In our last episode, we laid the groundwork for managing brain metastases. Today, we tackle one of the most significant paradigm shifts in modern radiation oncology: the move away from routine whole-brain radiotherapy for patients with a limited number of brain metastases. For decades, WBRT was the standard. Now, for many patients, it's an inferior option. We will walk through the chronological st...

Brain metastases are the most common intracranial tumor in adults, and their management has undergone a complete revolution. Before we can treat, we must be able to prognosticate and have a firm grasp of the foundational principles. Today, we will cover the essential background, including epidemiology and workup. We will master the modern prognostic indices, including the Disease-Specific Graded P...

This is Episode 8: Low-Grade Glioma Part 3: Treatment Planning & Case-Based Review. Over the last two episodes, we've built the complete evidence-based framework for managing WHO Grade II gliomas. We've learned how to risk-stratify patients, when to treat, and what regimen to use. Today, we put that knowledge into practice. We'll start with a deep dive into the technical details of treatment p...

This is Episode 7: Low-Grade Glioma Part 2: Evidence for Chemo, Dose, and IDH Inhibitors. In our last episode, we established the framework for managing Grade II gliomas, answering the crucial question of when to treat. Today, we address the next logical question: for those high-risk patients we decide to treat, how do we treat them? We will dissect the pivotal evidence that transformed our approa...

This is Episode 6, and we are kicking off our new mini-series on Low-Grade Gliomas. Today's episode is titled: "LGG P1: Foundations, Risk Stratification & The Timing Debate."For years, the management of WHO Grade II gliomas has been one of the most debated topics in neuro-oncology. These tumors often occur in young, otherwise healthy individuals and have a long natural history, making the deci...

In our first four episodes, we've established the "what" and the "why" of high-grade glioma management. Today, we get practical and move to the "how." Treatment planning is a core competency for any radiation oncologist, and for high-grade gliomas, it's a discipline of millimeters and nuanced judgments.