RadOnc Smart Review

Today, we shift our focus to managing advanced and recurrent rectal cancer. We will outline the systemic therapy options for metastatic colorectal cancer, including the roles of specific chemotherapies and biologics based on molecular markers. We'll then discuss the critical management of lateral pelvic lymph nodes. Finally, we'll delve into the complex, yet often life-saving, principles of pelvic...

Over the last three episodes, we have constructed the entire modern framework for rectal cancer management. We’ve established when to treat, how to treat, and who to treat with advanced strategies like TNT and immunotherapy. Today, we bring it all to the treatment planning console. This is the practical application episode. We will provide a step-by-step guide to modern rectal cancer contouring ba...

In our previous discussions, we've firmly established the role of neoadjuvant radiation therapy for locally advanced rectal cancer. However, radiation, while life-saving, comes with its own set of acute and late toxicities—from sexual dysfunction and infertility to chronic bowel changes and the rare risk of secondary malignancies. This raises a crucial question in modern oncology: for whom can we...

In our last episode, we explored Total Neoadjuvant Therapy, or TNT, which has revolutionized the management of high-risk locally advanced rectal cancer by increasing pathologic complete response, or pCR, rates and improving distant control. These impressive pCR rates have opened the door to one of the most exciting and debated topics in rectal cancer: avoiding major surgery through "Watch and Wait...

In our last episode, we established the foundational principles of neoadjuvant radiation, proving that giving RT before surgery is superior and comparing the short-course and long-course approaches. That framework is perfect for standard-risk disease. But for patients with the highest-risk tumors, the primary driver of mortality isn't local failure—it's distant metastases. This reality has sparked...

In our last episode, we established the fundamental clinical landscape of rectal cancer—the anatomy, the critical role of MRI in staging, and the surgical revolution of Total Mesorectal Excision. We learned that with high-quality TME, surgeons could dramatically reduce local recurrence. The question then became: could we improve upon this new surgical standard?

If there is one disease site that perfectly illustrates the power of multidisciplinary, evidence-based cancer care, it’s rectal cancer. The evolution of its treatment is a masterclass in how surgery, radiation, and chemotherapy can be integrated to dramatically improve outcomes. But before we can appreciate that evolution, we must master the fundamentals. Today, we lay the groundwork for this enti...

Today, we conclude our liver mini-series by tackling these crucial topics. F irst, we’ll cover the evidence-based management for biliary tract cancers—including gallbladder cancer and cholangiocarcinoma—with a focus on the patterns of failure that guide our use of adjuvant radiation. Then, we’ll pivot to one of the most common clinical scenarios we face: treating colorectal liver metastases, discu...

Today, we conduct our SBRT masterclass for HCC. We will make the definitive case for SBRT over other local therapies by citing the key comparative data. We'll detail the evidence for treating high-risk disease like portal vein thrombosis and walk through the critical dosimetric details—ablative doses, the RTOG 1112 de-escalation schema, and the crucial constraints you need to know to treat safely...

Welcome back to Rad Onc Smart Review, GI Series. T his is Episode 12: HCC Part 1: The HCC Toolkit – Staging, IR, and Systemic Therapy . Hepatocellular carcinoma, or HCC, is a unique beast in oncology. Unlike most cancers where our focus is solely on the tumor, in HCC we are fighting a war on two fronts: the cancer itself, and the often-diseased liver it inhabits. This dual challenge means that sta...

Over the last three episodes, we've journeyed through the complex evidence for pancreatic cancer. We’ve dissected the adjuvant debate, explored the neoadjuvant revolution, and held a masterclass on SBRT. Now, it’s time to put it all together. This is our synthesis episode, where we translate the data from landmark trials into practical, actionable plans. We will start by summarizing the key recomm...

In our last two episodes, we focused on patients with resectable or borderline resectable pancreatic cancer—those for whom surgery is the ultimate goal. Today, we turn to a different, but equally challenging scenario: the patient with locally advanced, unresectable disease. These are the patients whose tumors are intimately involved with the major blood vessels, taking surgery off the table, but w...

Welcome back to Rad Onc Smart Review, GI Series. In our last episode, we wrestled with the difficult data for adjuvant therapy, where even after a grueling Whipple procedure, the prognosis remains guarded. This reality has fueled one of the most significant paradigm shifts in modern GI oncology: moving therapy from the postoperative to the preoperative setting. The rationale is simple yet powerful...

Welcome back to Rad Onc Smart Review, GI Series. Pancreatic cancer carries one of the most sobering prognoses in oncology. For the small fraction of patients who present with resectable disease, surgery offers the only hope for a cure. But even after a successful resection, the risk of recurrence is incredibly high, making effective adjuvant therapy a critical component of care. For decades, the q...

In our last episode, we established that for resectable gastric cancer, high-quality D2 surgery and effective perioperative chemotherapy with FLOT is the modern standard of care. But that raises a critical question for us as radiation oncologists: what is the role of radiation therapy in this disease? Today, we answer that question by dissecting the landmark trials of adjuvant chemoradiation, expl...

Welcome back to Rad Onc Smart Review, where we break down the clinical decisions that matter most in radiation oncology. This is Episode six: Gastric Cancer Part one, covering Surgery and Perioperative Chemotherapy. Gastric cancer remains a major global health challenge. While less common in the United States, it’s the third leading cause of cancer-related death worldwide, often because it's diagn...

This is Episode 05: Esophagus Part 4: NOM, Advanced Disease & Treatment Planning. This is our capstone episode on esophageal cancer. We’ve covered the fundamentals, the landmark trials, and the modern debates. Today, we bring it all together. We’ll explore the exciting frontier of non-operative management, clarify the algorithm for using immunotherapy in advanced disease, and then roll up our...

This is Episode 04: Esophagus Part 3: The Dose Escalation & Adjuvant IO Debates. In our last episode, we laid the foundation with the landmark trials establishing neoadjuvant and definitive chemoradiation. But a key principle in oncology is to always ask: can we do better? Today, we tackle the controversies and innovations that have attempted to improve upon those standards. We’ll dissect the...

This is Episode 03: Esophagus Part 2: Neoadjuvant & Definitive CCRT.In our last episode, we laid the groundwork for esophageal cancer management. Now, we move to the heart of the matter: how we treat locally advanced disease. This episode is all about the landmark trials that defined the role of chemoradiation. We'll dissect the two pillars of modern esophageal radiation oncology: RTOG eighty-...

This is Episode 02: Esophagus Part 1: Anatomy, Staging & Surgical Options. Getting the fundamentals right in esophageal cancer is everything. It's a disease where anatomy dictates treatment fields, staging dictates modality, and surgical approach dictates potential toxicities. Today, we'll build that crucial foundation, covering the anatomy and workup that drive our initial decisions, the nuan...

Welcome back to Rad Onc Smart Review, G.I. Oncology Edition. This is Episode 01: GI Principles: Re-RT, Toxicity, & Contouring Rare Sites. Before we dive deep into specific GI malignancies, we’re going to build a strong foundation. This episode covers four high-yield topics that cut across multiple disease sites: re-irradiation of the pelvis, management of chronic radiation proctitis, contourin...

Welcome back to Rad Onc Smart Review! This is Episode 39C in our special series on Radiobiology Calculations. Today, we’re tackling the mathematics that underpins the very foundation of modern radiation therapy: fractionation. Why do we give many small doses of radiation instead of one big one? The answer lies in the numbers, and mastering these calculations is essential for both your board exams...

Welcome back to Rad Onc Smart Review! This is Episode 39B, the second installment of our special series on Radiobiology Calculations. Today, our focus is on Tumor Control & Kinetics. In our last episode, we mastered the calculations for cell survival on a microscopic level. Now, we're scaling up to the macroscopic world of clinical tumors. We'll start by calculating the massive radiation doses...

Welcome back to Rad Onc Smart Review! This is Episode 39A, and the first in our special series on Radiobiology Calculations. In this episode, Calculations 1: Quantifying Cell Survival, we're moving beyond concepts and getting our hands dirty with the numbers. We'll start with the foundational laboratory data from clonogenic assays and walk step-by-step through calculating Plating Efficiency and Su...

Today, we're doing a rapid-fire, high-yield review of the absolute must-know concepts, formulas, and numbers for your board exams. We'll move quickly through seven key domains, from fundamental physics to advanced modalities and safety guidelines. Let's begin.