RadOnc Smart Review

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.

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...