RadOnc Smart Review

Episode 30: Anal Response, Surveillance, Toxicity, Salvage, and Future Directions.After anal chemoradiation, a resolving lesion and progressive disease call for different decisions. In this episode, we distinguish response-assessment timelines, surveillance, biopsy and salvage, while addressing acute and late toxicity, function, and survivorship. We close by examining emerging treatment directions in relation to their endpoints and evidence maturity.

Episode 29: Anal IMRT Planning: Simulation, Contouring, Dose Painting, and Special Populations.A correct prescription alone does not guarantee a sound anal IMRT plan. In this episode, we work through reproducible simulation, gross and elective target delineation, nodal compartments, dose painting, and organ-at-risk objectives, then distinguish sequential boosts from genuine adaptation and address special patient considerations.

Episode 28: Anal Chemoradiation: Chemotherapy, Dose, Timing, and Evidence.A complete anal chemoradiation plan brings together concurrent chemotherapy, target-specific dose, and treatment timing. In this episode, we examine the evidence behind regimen choices, interpret RTOG 98-11 and ACT II in context, and discuss toxicity management, avoidable treatment gaps, and the limits of emerging reduced-dose strategies.

Episode 27: Anal Cancer Foundations: Anatomy, Staging, Workup, and the Nigro Paradigm.Anal cancer management begins by locating the primary and distinguishing anal canal from anal margin disease. In this episode, we review examination, imaging, lymphatic drainage, staging, and patient context, then trace the Nigro paradigm and the evidence that established organ-preserving chemoradiation.

Episode 26: Rectal Planning, Pelvic Recurrence, Reirradiation, Toxicity, and Survivorship.Initial rectal treatment and pelvic recurrence both require a careful reconstruction of anatomy and treatment intent. In this episode, we work through simulation, targets, dose, salvage assessment, and prior-plan review for reirradiation, then connect technical planning with bowel, urinary, sexual, and other survivorship concerns.

Episode 25: Rectal Organ Preservation: Watch-and-Wait and dMMR Immunotherapy.Rectal organ preservation depends on more than a reassuring scan. In this episode, we examine clinical response assessment, watch-and-wait surveillance, regrowth and salvage, and the OPRA sequence, then consider the separate dMMR immunotherapy pathway with attention to biomarker confirmation, follow-up, and the maturity of the evidence.

Episode 24: Selective Radiation Omission: PROSPECT, Upfront Surgery, and Local Excision.Selective radiation omission in rectal cancer requires a defined treatment algorithm and careful eligibility assessment. In this episode, we reconstruct PROSPECT selection, chemotherapy, response assessment, and rescue chemoradiation, then distinguish that pathway from upfront surgery and local excision in separately selected patients.

Episode 23: Total Neoadjuvant Therapy: RAPIDO, PRODIGE 23, STELLAR, and OPRA.Total neoadjuvant therapy is a set of treatment strategies, not a single regimen. In this episode, we compare RAPIDO, PRODIGE 23, STELLAR, and OPRA in their own populations and sequences, examining distant control, local recurrence, treatment intensity, and organ-preservation endpoints without declaring a universal cross-trial winner.

Episode 22: Rectal Neoadjuvant Radiation: Long Course, Short Course, and Surgical Timing.Long-course chemoradiation and short-course radiation are treatment platforms whose timing and purpose matter. In this episode, we compare their evidence, patient selection, concurrent chemotherapy, and relationship to surgery, including the role of delayed surgery after short-course treatment and the goals of regression and organ preservation.

Episode 21: Rectal Cancer Foundations: MRI Staging, Anatomy, TME, and Risk Stratification.Rectal cancer treatment begins with a precise anatomic and MRI-based assessment. In this episode, we review tumor height, pelvic anatomy, mesorectal fascia, vascular invasion, nodal compartments, and total mesorectal excision, then connect those findings with risk stratification and the choice of an initial treatment pathway.