RadOnc Smart Review

This is Episode 21: Oropharynx Capstone Mock Oral Boards. Today, we simulate the oral boards exam in five clinical blocks. Each block features a longitudinal case that escalates through workup, staging, treatment selection, planning priorities, and outcomes. Then we close each block with a shorter twist that tests a key decision pivot. Treat this like a live exam. After every question, you will he...

This is Episode 20: Functional Outcomes and Survivorship in Oropharyngeal Cancer. Today is about what boards actually test when they say “survivorship”: whether you understand the *functional price* of cure, and whether you can prove you planned thoughtfully to reduce that price. This episode is going to be constraint-forward. We are going to use a conventional fractionation constraint library (QU...

Today is the curveball episode. Boards love these scenarios because they test judgment, sequencing, and restraint. We will do three things. First, we will contrast the tobacco-associated, p16-negative oropharynx patient with the favorable HPV-positive population, because there is no de-escalation lane here. Second, we will develop a clean, board-safe, and unknown primary workup that escalates logi...

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 18B: The Post-Operative Oropharynx Planning Workshop. Episode Eighteen was the clinic decision: who gets observation, who gets P-O-R-T, and who needs post-op chemoradiation after transoral surgery for H-P-V-positive oropharyngeal cancer. Episode Eighteen-B is the execution: you already decided “radiation alone” or “chemor...

This is Episode 18: TORS and De-Escalation. Today we tackle one of the most controversial and actively evolving areas in head and neck oncology: the role of transoral robotic surgery and treatment de-intensification for H-P-V-positive oropharyngeal cancer. This is exceptionally high-yield for boards because examiners love to test whether you can distinguish proven standards from promising-but-inve...

This is Episode 17b: Definitive Planning Workshop Simulation, Target Volumes, and OAR Constraints. In Episode 17, we covered the clinical decision-making for definitive chemoradiation—why we treat, who needs systemic therapy, and which agent to use. Now we're at the contouring workstation, and we need to answer the technical questions: *How* do we treat? This episode is high-yield for both written...

This is Episode 17: Definitive Chemo-RT Cisplatin is King. This episode is essential for boards. If you remember one thing from today, let it be this: *cisplatin is king*. Concurrent cisplatin with radiation is the standard of care for locally advanced head and neck cancer requiring systemic therapy—and multiple randomized trials have now proven that cetuximab is *not* an acceptable substitute, ev...

This is Episode sixteen: Oropharynx Foundations, H.P.V. Biology, and A.J.C.C. Eighth Edition Staging. Today we begin a new block, and I want to set the stage with something fundamental: oropharynx cancer is not one disease. It is two biologically distinct diseases that share an anatomic region. H.P.V. positive oropharynx cancer is virally driven, occurs in a different patient population, and has d...

Today, we simulate the oral board exam in five blocks. Each block has a multi-step main case, then a shorter twist that tests a different high-yield decision point for the same scenario. Treat this as a live exam. Pause after each question to formulate your response. Let’s begin.

This is Episode 15B: Subsite-Specific Coverage for Oral Cavity Cancer. You’re sitting at the contouring workstation with a post-operative oral cavity case loaded. The C-T simulation is fused with the best available preoperative imaging. The surgeon has sent you the operative report. And now you face the questions that define whether your plan is correct:Which nodal levels need coverage? Ipsilatera...

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...