RadOnc Smart Review

Episode 2 draft

This is Episode 1: Prostate – Anatomy, Pathology, Risk Groups, and Natural History. This foundational episode covers everything in the prostate series – dose escalation, hypofractionation, brachytherapy, ADT integration, salvage, and oligometastatic management – as we delve deep into three key areas. First, prostate anatomy, including zonal architecture, lymphatic drainage, and adjacent structures...

This is Episode 39a: Sinonasal II Maxillary and Ethmoid SCC and SNUC Management. In our last episode, we established the anatomic and histologic foundations for sinonasal cancers. Now, we apply that knowledge. This clinical decision-making episode will guide you through NCCN algorithms for maxillary and ethmoid sinus tumors. We'll cover recommending elective neck irradiation, orbital preservation...

This is Episode 38: Sinonasal I Anatomy, Histology Diversity, and Multimodality Logic. We are now entering a block of head and neck oncology that is genuinely unique. Sinonasal cancers represent fewer than 2,000 cases per year in the United States — less than 1% of all malignancies — yet they pack an outsized punch on written and oral board examinations. Why? Because these tumors test everything a...

Today we simulate the oral boards exam in three clinical blocks plus a lightning round. Block One walks through comprehensive postoperative management. Blocks Two and Three test specific decision pivots, perineural invasion stop points and metastatic biomarker-driven therapy. Then we close with rapid-fire pearls.

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 37: Salivary Gland Four – Unresectable Disease and Advanced Approaches. This episode completes our Salivary Gland block. We have built the foundation – histology-driven biology in Episode 34, adjuvant R-T triggers and planning in Episode 35, and perineural invasion strategy in Episode 36. Today we address difficult cases:...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 36: Salivary Gland Three — Perineural Invasion and Named Nerve Strategy. Perineural invasion is the defining challenge of salivary gland radiation oncology. It is why adenoid cystic carcinoma behaves differently from mucoepidermoid. This is why some tumors recur at the skull base years after treatment. And it is absolutel...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 35: Salivary Gland Two — Adjuvant RT Triggers and Planning. In Episode 34, we built the salivary gland paradigm: histology leads, surgery is primary, and adjuvant decisions are driven by risk factors that salivary tumors love to hide—especially perineural invasion and margin risk. Today is the bridge episode. We take our...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 34: Salivary Gland One — Histology-Driven Biology and the Surgical Paradigm. This episode launches our salivary gland block, and I want to be direct: salivary gland cancers are a board favorite because they force you to think differently. Unlike mucosal squamous cell carcinomas, where HPV status and TNM staging drive almo...

This is Episode 33: Hypopharynx Integration Decision Points and Surveillance. Episode 31 covered the biology, including the worst-actor paradigm, prognosis, and the four defaults. Episodes 32 and 32b focused on planning: contouring, extension, and coverage. Now, we address the integration question: Who receives which treatment, and what does success look like? This episode explores decision-making...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 32b: Hypopharynx Planning Workshop. Episode 32 gave you the rules, the four defaults, the nodal template, the inferior extent ladder, and the OAR priorities. Today, we build muscle memory. We're at the contouring workstation. Two complete cases. No new teaching pure application and narrated decision-making. Here's what I...

In Episode 31, we established the foundational paradigm for hypopharyngeal cancer, the worst-actor subsite in head and neck oncology. We defined four defaults that govern our approach to these cases: Default one: retropharyngeal nodes on. Default two: bilateral neck on. Default three: inferior extent on. Default four: prognosis is brutal, plan accordingly. Today, we translate those defaults into a...

This is Episode Thirty-One: Hypopharynx One — Anatomy, Prognosis, and the Worst-Actor Paradigm. Today we tackle the subsite that earns its reputation as the worst actor in head and neck oncology. Hypopharyngeal cancer presents late, spreads early, and hides submucosally—which means your default choices must be aggressive from the start. This episode is foundational. We will not contour a single st...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 30: Larynx Capstone – Mock Oral Board Review. Today we simulate the oral boards exam in four clinical blocks. Each block features a case that escalates through workup, staging, treatment selection, planning priorities, and outcomes. We'll close each block with a twist testing a key decision pivot. Treat this like a live e...

This episode, number 29, focuses on Advanced Larynx T4a and the Unpreservable. Building upon Episode 28's discussion of organ preservation, we explore instances where such preservation is not the optimal course of action. Specifically, we examine how to identify patients for whom maintaining the larynx is either impractical or detrimental. Given the natural inclination to offer preservation, this...

This episode, number 28, explores "Organ Preservation: The Landmark Trials." Prior to 1991, the standard treatment for advanced laryngeal cancer involved total laryngectomy and radiation, which, while ensuring patient survival, resulted in the loss of natural voice, the inability to breathe through the nose and mouth, and a permanent stoma. A pivotal question emerged: could equivalent survival rat...

This is Episode 27b: Early Larynx Planning Workshop. In Episode 27, we addressed the fundamental aspects, including the radiocurability of early glottic cancer, the standard fractionation of 2.25 Gy/fx, and the rationale for neck sparing due to a nodal risk of less than 5%. This session focuses on the practical application—transferring this knowledge to the planning stage to develop a defensible a...

This is Episode 27: Early Glottic Cancer Fields, Fractionation, and Voice Preservation. Early glottic cancer represents the prototype of a radiation-curable malignancy. It is one of the few oncological sites where we routinely achieve patient cures through radiation therapy alone, preserving the organ while attaining functional outcomes that surgery often fails to match. For T1 glottic cancer, 5-y...

This is Episode 26: Larynx I- Anatomy, Staging, and the Organ Preservation Philosophy. The larynx holds a unique position in head and neck oncology. It is the one subsite where we routinely achieve cancer cures while preserving organ function. In early glottic cancer, radiation therapy achieves local control rates exceeding 90 percent with excellent voice outcomes. In advanced disease, concurrent...

This is Episode 25: Nasopharynx Capstone – Mock Oral Boards. Today, we will simulate the oral board examination through four clinical blocks. Each block presents a case that progresses from workup to staging, treatment selection, planning priorities, and outcomes. Each block concludes with a twist designed to test a key decision point. Please treat this as a live examination.

This is Episode 24b: The Nasopharynx Planning Workshop, which focuses on skull base abutment cases. In the preceding episodes, we established the clinical framework for nasopharyngeal carcinoma, encompassing anatomy, staging, EBV biology, systemic therapy sequencing, response assessment, and salvage strategies. We now transition to the planning workstation, where the decisions made within the next...

This is Episode 24: Nasopharynx IV Response Assessment and Salvage. Building upon the previous two episodes, we have established that nasopharyngeal carcinoma is a radiation-driven disease. We have reviewed the anatomy, EBV biology, staging, and evidence supporting concurrent chemoradiation, with or without induction. Now, we address the critical question patients will invariably pose: "Did it wor...

This episode, number 23, focuses on Nasopharynx III Induction and Concurrent Systemic Therapy. Building on Episode 22, where we established NPC as a radiation-driven disease with unique anatomy and EBV biology, and Episode 22b, where we covered target volumes, we now delve into the systemic therapy backbone, the chemotherapy decisions that determine patient outcomes. This high-yield episode highli...

In Episode 22, we framed nasopharyngeal carcinoma as a radiation-driven disease with distinct anatomy, EBV association, and AJCC 8 edition staging built around skull base landmarks. Now we do the part that oral boards loves: designing the plan.

This is Episode 22: Nasopharynx I Anatomy, E. B. V. Biology, and the Definitive R. T. Paradigm. Nasopharyngeal carcinoma is a board-favorite because it behaves unlike the rest of the head and neck. It is a radiation-first disease with skull base anatomy, retropharyngeal nodes as default, and a biomarker you are expected to talk about fluently: plasma E. B. V. D. N. A.