RadOnc Smart Review

This is Episode 31: Penile and Urethral Planning Workshop. These are rare, high-stakes plans. The anatomy is mobile, the setup can be awkward, the evidence base is limited, and sloppy field design can have major consequences. This workstation episode covers simulation, bolus, immobilization, penile brachytherapy, inguinal and pelvic nodal contouring using the InPACT framework, and key principles o...

This is Episode 30: Penile Cancer Primary Management, Nodes, and Organ Preservation. Penile cancer is rare, but it is very fair game on boards because it tests whether you can keep anatomy, staging, nodal logic, and quality-of-life tradeoffs straight in a disease most residents will see only rarely.

Today we will build a practical framework for workup, staging, histology, and multimodality management. We will also cover where radiation fits, including selected use of brachytherapy for early-stage female disease and definitive chemoradiation for selected locally advanced squamous tumors.

This is Episode 28: Upper Tract Urothelial Carcinoma perioperative therapy, patterns of failure, and where radiation enters the conversation. UTUC is one of those diseases that residents do not see often, but oral examiners love it because it looks familiar and then punishes shortcut thinking. The histology overlaps with bladder urothelial carcinoma, but the risk stratification, the surgical plann...

This is the workstation episode. This is the planning episode. The big idea is simple: kidney SBRT is usually a motion-management problem and an organ-at-risk problem before it becomes a dose problem. Your bowel, your duodenum, your stomach, and the remaining uninvolved renal parenchyma often decide the regimen.

This is one of the highest-yield modern RCC topics because it sits right where three practice changes collide. First, RCC was long treated as a disease that did not respond well to conventional radiation, but modern ablative radiation changed that conversation. Second, cytoreductive nephrectomy went from reflex dogma to a selective, risk-adapted decision. Third, immune checkpoint inhibitor–based c...

This is Episode 24: Renal Cell Carcinoma Localized Disease, Surgery, Ablation, and Primary SBRT. Here is the modern frame. Localized RCC is still primarily a surgical disease. Conventional fractionation never established a curative or adjuvant role in this setting. But stereotactic ablative body radiotherapy has changed the conversation for selected patients who are medically inoperable, technical...

This episode is about what happens after cure. Testicular cancer is one of the great success stories in oncology, but that success creates a second job: taking care of survivors for decades. These are often young men with excellent cure rates and long life expectancy. So the real question is not just whether you cured the cancer. It is whether you protected fertility, recognized relapse on the rig...

This is the episode where testicular cancer stops being mostly about stage I and stage II decision trees and starts becoming a sequencing problem. The questions are no longer just surveillance versus adjuvant therapy. Now the important questions are: how do you classify risk correctly, which chemotherapy backbone belongs to which group, when does PET help, when does it not help at all, who needs s...

This is Episode 20: Testicular Stage II Seminoma, NSGCT, and Field Design. Last episode, we built the foundation: markers, orchiectomy, staging, and why surveillance is preferred for most stage I seminoma. Today we move into stage II disease, where the question is no longer just whether you know the basics. The question is whether you can choose treatment, explain why, and, if needed, describe a r...

This is Episode 19: Testicular Cancer - Workup, Markers, Staging, and Stage I Seminoma. Testicular cancer is uncommon overall, but it is the most common solid malignancy in young men, and it is one of the great cure stories in oncology. That changes the way we think about treatment. The question is often not whether cure is possible. The question is how to preserve cure while minimizing overtreatm...

This is Episode 17: metastatic urothelial cancer, immunotherapy, and future directions. This is one of the fastest-moving areas in GU oncology. For years, first-line treatment for metastatic urothelial cancer meant platinum-based chemotherapy, with median overall survival in the mid-teens. That changed with EV-302. For many patients, the preferred first-line regimen is now enfortumab vedotin plus...

This is Episode 16: Bladder Post-Cystectomy Radiation, Follow-Up, and Salvage Pathways. This episode is high-yield because it addresses two common bladder cancer mistakes. First, it corrects the simplistic answer that radiation has no role after cystectomy. Second, it clarifies the need to act promptly when a patient, previously treated with trimodality therapy, experiences an invasive recurrence....

This is Episode 15: Bladder Planning Workshop - Definitive Preservation Cases. The last episode focused on who qualifies for trimodality therapy and why concurrent chemoradiation is preferred over radiation alone. Today's planning episode covers how to simulate, contour, choose volumes, and make technically defensible decisions when the bladder is moving, deforming, and sitting right next to the s...

This is Episode 14: Bladder Trimodality Therapy, Radiosensitizers, and Hypofractionation. Here's the key takeaway: bladder-preserving trimodality therapy is a viable curative option, not a last resort. In the right patients, it's a legitimate strategy, deserving of discussion alongside radical cystectomy. To excel on exams, present it correctly: prioritize candidate selection, use concurrent radio...

This is Episode 13: Bladder Cancer – Non-Muscle-Invasive and Muscle-Invasive Workup and the Surgical Backbone. Here's why this episode matters: Bladder cancer is a disease where radiation oncologists can be indispensable members of a curative bladder-preservation team, or completely absent from meaningful treatment discussions. The difference often comes down to understanding the surgical and medi...

This is Episode 11: Prostate Follow-up, Toxicity, Survivorship, and Failure Patterns. This is a high-yield episode because most prostate teaching focuses on the front end: risk stratification, dose, fractionation, and ADT duration. However, in the real clinic, a huge share of what you do is follow-up. You will spend more time interpreting PSA trends, counseling men about late effects, and managing...

This is Episode 10: Prostate Planning Workshop intact, post-op, and nodal cases. For the last several episodes, we've discussed what to treat in prostate cancer – risk groups, ADT duration, brachy boost candidates, and salvage triggers. Today, we're flipping the camera around and talking about how you actually deliver that plan. This is the episode where we sit down at the contouring station toget...

Welcome back to Rad Onc Smart Review, Genitourinary Oncology edition. This is Episode 9: a discussion on prostate cancer across the metastatic continuum, including metastatic hormone-sensitive disease, nonmetastatic castration-resistant disease, metastatic castration-resistant disease, metastasis-directed therapy, and precision systemic therapy. We'll cover how to move from localized to advanced d...

Episodes 3 through 7 covered definitive treatment. This episode covers what to do when definitive treatment fails. After prostatectomy, earlier salvage RT at lower PSA is associated with better outcomes. After prior RT or focal therapy, salvage can still be curative in selected patients, but it requires careful restaging and biopsy confirmation before local retreatment. Today we will cover four th...

The first three episodes established the foundation – anatomy, risk groups, workup, and surveillance. Now, we begin treatment. This episode explores the physics and biology of dose delivery to the prostate. We'll cover three key areas: First, the benefits of higher doses for biochemical control and what long-term data reveals about distant metastasis and cancer-specific mortality. Second, the rise...

E07 Draft

E06 draft

E05 draft

Episode 3 draft