RadOnc Smart Review

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...

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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...