RadOnc Smart Review

Episode 30: Anal Response, Surveillance, Toxicity, Salvage, and Future Directions. After anal chemoradiation, a resolving lesion and progressive disease call for different decisions. In this episode, we distinguish response-assessment timelines, surveillance, biopsy and salvage, while addressing acute and late toxicity, function, and survivorship. We close by examining emerging treatment direction...

Episode 29: Anal IMRT Planning: Simulation, Contouring, Dose Painting, and Special Populations. A correct prescription alone does not guarantee a sound anal IMRT plan. In this episode, we work through reproducible simulation, gross and elective target delineation, nodal compartments, dose painting, and organ-at-risk objectives, then distinguish sequential boosts from genuine adaptation and address...

Episode 28: Anal Chemoradiation: Chemotherapy, Dose, Timing, and Evidence. A complete anal chemoradiation plan brings together concurrent chemotherapy, target-specific dose, and treatment timing. In this episode, we examine the evidence behind regimen choices, interpret RTOG 98-11 and ACT II in context, and discuss toxicity management, avoidable treatment gaps, and the limits of emerging reduced-d...

Episode 27: Anal Cancer Foundations: Anatomy, Staging, Workup, and the Nigro Paradigm. Anal cancer management begins by locating the primary and distinguishing anal canal from anal margin disease. In this episode, we review examination, imaging, lymphatic drainage, staging, and patient context, then trace the Nigro paradigm and the evidence that established organ-preserving chemoradiation.

Episode 26: Rectal Planning, Pelvic Recurrence, Reirradiation, Toxicity, and Survivorship. Initial rectal treatment and pelvic recurrence both require a careful reconstruction of anatomy and treatment intent. In this episode, we work through simulation, targets, dose, salvage assessment, and prior-plan review for reirradiation, then connect technical planning with bowel, urinary, sexual, and other...

Episode 25: Rectal Organ Preservation: Watch-and-Wait and dMMR Immunotherapy. Rectal organ preservation depends on more than a reassuring scan. In this episode, we examine clinical response assessment, watch-and-wait surveillance, regrowth and salvage, and the OPRA sequence, then consider the separate dMMR immunotherapy pathway with attention to biomarker confirmation, follow-up, and the maturity...

Episode 24: Selective Radiation Omission: PROSPECT, Upfront Surgery, and Local Excision. Selective radiation omission in rectal cancer requires a defined treatment algorithm and careful eligibility assessment. In this episode, we reconstruct PROSPECT selection, chemotherapy, response assessment, and rescue chemoradiation, then distinguish that pathway from upfront surgery and local excision in sep...

Episode 23: Total Neoadjuvant Therapy: RAPIDO, PRODIGE 23, STELLAR, and OPRA.Total neoadjuvant therapy is a set of treatment strategies, not a single regimen. In this episode, we compare RAPIDO, PRODIGE 23, STELLAR, and OPRA in their own populations and sequences, examining distant control, local recurrence, treatment intensity, and organ-preservation endpoints without declaring a universal cross-...

Episode 22: Rectal Neoadjuvant Radiation: Long Course, Short Course, and Surgical Timing. Long-course chemoradiation and short-course radiation are treatment platforms whose timing and purpose matter. In this episode, we compare their evidence, patient selection, concurrent chemotherapy, and relationship to surgery, including the role of delayed surgery after short-course treatment and the goals o...

Episode 21: Rectal Cancer Foundations: MRI Staging, Anatomy, TME, and Risk Stratification. Rectal cancer treatment begins with a precise anatomic and MRI-based assessment. In this episode, we review tumor height, pelvic anatomy, mesorectal fascia, vascular invasion, nodal compartments, and total mesorectal excision, then connect those findings with risk stratification and the choice of an initial...

Episode 20: Rare GI Malignancies: Small Bowel, Duodenum, Appendix, GIST, and Neuroendocrine Tumors. Rare gastrointestinal malignancies do not share a single treatment pathway. In this episode, we distinguish small bowel and duodenal cancers, appendiceal tumors, GIST, and neuroendocrine neoplasms, using histology, grade, differentiation, site, and stage to organize management and place radiation in...

Episode 19: Colorectal Oligometastases: Liver and Lung Surgery, Ablation, SBRT, and COLLISION.Choosing a local treatment for colorectal liver or lung metastases starts with whether complete clearance is feasible. In this episode, we compare the roles of surgery, ablation, and SBRT within multidisciplinary care, examine the COLLISION evidence, and discuss how disease distribution and systemic treat...

Episode 18: Metastatic Colorectal Cancer: Molecular Selection and Systemic Therapy. A first-line metastatic colorectal cancer plan needs a complete molecular and clinical picture. In this episode, we examine mismatch repair, RAS, BRAF, HER2, other actionable alterations, and primary sidedness, then connect those findings with systemic treatment selection, disease tempo, resectability, symptoms, an...

Episode 17: Localized Colon Cancer: Staging, Surgery, Adjuvant Therapy, and the Limited Role of Radiation. After colon cancer surgery, the next step depends on stage, pathologic risk, mismatch-repair status, and the precise site of the primary. In this episode, we review staging, surgery, and adjuvant therapy, then define the limited circumstances in which radiation enters the discussion and the q...

Episode 16: Advanced Biliary Tract Cancer: Systemic Therapy, Biomarkers, and Local Therapy. Advanced biliary tract cancer care must bring urgent biliary problems, systemic treatment, and molecular profiling into the same plan. In this episode, we examine anatomic subtype, obstruction and infection, first-line therapy, biomarker-directed options, and the selective use of local treatment, with atten...

Episode 15: Resectable Biliary Tract Cancer: Surgery, Adjuvant Therapy, and Radiation. A postoperative biliary cancer referral needs more detail than a diagnosis and a positive-margin label. In this episode, we connect anatomic subtype, the operation, pathology, and recurrence risk to adjuvant treatment decisions, exploring the evidence and the role of radiation within a multidisciplinary plan.

Episode 14: HCC Radiation: EBRT, SBRT, Protons, Planning, and Integration. Radiation for HCC requires a clear local-treatment goal and careful protection of the remaining liver. In this episode, we examine EBRT, SBRT, protons, and their integration with other therapies, review comparative evidence including RTOG 1112, and work through prescription, biliary and luminal risks, and a practical planni...

Episode 13: HCC Foundations: Diagnosis, Liver Function, Staging, and Multidisciplinary Selection. An HCC treatment decision depends on both the cancer and the liver that must tolerate treatment. In this episode, we work through diagnosis, liver reserve, portal hypertension, staging, and multidisciplinary selection, showing why these foundations need to be established before choosing a local or sys...

Episode 12: Pancreas Planning Workshop: Simulation, Targets, Motion, and Constraints. A pancreatic radiation prescription must fit the patient's anatomy and the motion seen at simulation. In this planning workshop, we work through simulation, image registration, target definition, respiratory motion, and organ-at-risk constraints. The discussion connects technical choices with treatment safety whe...

Episode 11: Locally Advanced Pancreas: Chemotherapy, Chemoradiation, SBRT, and Adaptation. For a patient with locally advanced pancreatic cancer, treatment goals and the limits of each modality need to be clear from the start. In this episode, we examine systemic therapy, chemoradiation, SBRT, and adaptation, with attention to patient selection, local control, symptoms, and reassessment of surgica...

Episode 10: Resectable and Borderline-Resectable Pancreas: Perioperative Strategy. Choosing surgery first or preoperative therapy in pancreatic cancer requires more than a resectability label. In this episode, we compare clearly resectable and borderline-resectable pathways, review adjuvant evidence and the PREOPANC, PREOPANC-2, and A021501 trials, and examine response assessment, selective radiat...

Episode 9: Pancreatic Cancer: Workup, Anatomy, Staging, and Resectability. Pancreatic cancer needs both an anatomic stage and a clear description of resectability. In this episode, we follow a pancreatic-head presentation through diagnosis, imaging, obstruction management, surgical anatomy, and AJCC staging. We then examine how vessel contact, reconstructibility, tumor biology, and patient fitness...

Episode 8: Metastatic Gastric and GEJ Cancer: Biomarkers, Systemic Therapy, and Palliation. Metastatic gastric and GEJ cancer requires a treatment plan built around symptoms, fitness, goals, and biomarkers. In this episode, we review tissue assessment and the HER2, PD-L1, mismatch-repair, and claudin 18.2 dashboard, explore first-line and progression decisions, and connect systemic therapy with lo...

Episode 7: Gastric Radiation: Indications, Evidence, and Treatment Planning. Before planning gastric radiation, the team must define the local problem it is meant to address. In this episode, we examine the indications and trial evidence in the context of surgical quality, margins, and systemic therapy, then work through preoperative and postoperative target decisions, nonoperative care, and sympt...

Episode 6: Gastric Cancer Foundations: Staging, Surgery, and Perioperative Therapy. A gastric cancer treatment plan begins with the primary site, complete staging, surgical feasibility, and the patient's ability to complete multimodality care. In this episode, we follow an antral cancer case through pathology, staging, gastrectomy and D2 surgery, perioperative evidence including FLOT and MATTERHOR...