RadOnc Smart Review

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 3: Foundations III — Workup Masterclass: Scope, PET, Pan endo, and Biomarkers.Today is about the discipline of diagnosis.On oral boards, there is a specific way to fail a head and neck case before you ever draw a contour: you jump to treatment before you have established the diagnosis and stage. That signals immaturity. The examiner is not just testing whether you can plan IMRT. They are testing whether you can think like the attending who owns the whole patient.

This is Episode 2: Foundations II — Cranial Nerves, PNI Highways, and the Skull Base.**Last episode, we mapped lymphatics. Today, we map nerves.Because in head and neck oncology, **perineural invasion is not just a pathology word. It is geography.** It is a route problem. When tumor gets into a nerve, it can travel **from a peripheral skin site or gland to the skull base foramina**, and from there into deeper skull base compartments. That is why PNI changes your clinical target volume.

This is Episode 1: Foundations I — Neck Levels and Spaces That Change Volumes.We are starting this season with anatomy because in head and neck oncology, anatomy is destiny. If you do not understand the drainage pathways, you cannot draw the target. And if you cannot draw the target, you cannot cure the patient—or worse, you cure them but leave them with avoidable, life-altering toxicity. Today, we are not just memorizing lists. We are building the visual framework—the grid—that you will overlay on every CT scan you scroll through for the rest of your career. This is high-yield for written boards because they love drainage patterns, and it is survival for oral boards because a single missed nodal level on a contouring case is an automatic fail.

This is Episode 18: *Mock Oral Boards 2 – Vulvar, Vaginal, and Complex Recurrence Cases*. This is our **final episode in the GYN series**. In the **next series, we’ll move on to Breast cancer** and build a new mock oral framework there.**Examiner:** In Episode 17, we focused on cervical and endometrial cancer fundamentals and brachytherapy technique. Today we escalate to the “exam-separating” scenarios: unresectable vulvar and vaginal primaries, sentinel node management, pelvic recurrences, re-irradiation, and high-grade toxicities.When you hear the pause, answer out loud as if you are in the hot seat. I’ll then give you a polished performance script and a teaching pearl.

Today, we're not just reviewing content; we're practicing the *performance* of the oral boards. I will act as your examiner, providing board-style prompts for eight comprehensive cases, each with a contrasting twist. When you hear the pause, answer out loud, practicing a crisp, structured, and confident response.After each pause, I’ll give you a model answer—a polished performance script—followed by a key teaching pearl.We’ll cover definitive management of locally advanced cervical cancer, risk-stratified adjuvant therapy in endometrial cancer, and crucial techniques and plans for brachytherapy. Let’s begin.

Welcome back to Rad Onc Smart Review, GYN Series. This is Episode 16: GYN Brachytherapy — The Oral Boards Performance Guide. Today is a mock oral. I’ll ask; you answer. Then I’ll give teaching pearls. Focus on applicator selection, polished procedural scripts, hybrid escalation, plan read-outs, troubleshooting, and complications. Pause after each question to formulate your answer.

Ovarian cancer is dominated by surgery and systemic therapy. As radiation oncologists, we’re expert consultants who step in at critical junctures: to clarify staging and risk, to advise on maintenance systemic strategies that shape recurrence patterns, and to deliver highly conformal radiation for palliation or carefully selected oligometastatic disease. Today we’ll cover surgical staging and cytoreduction goals, the modern systemic landscape (including PARP inhibitors and HRD), and radiation’s niche roles—palliative EBRT and SBRT for oligometastatic or oligoprogressive disease.

Today we will master primary vaginal cancer from first principles to planning. We will start with epidemiology, pathophysiology, and the anatomy that dictates nodal targets. We will explain why definitive radiation is the backbone of curative therapy for most stages. Then we will design a complete plan that combines pelvic EBRT with a brachytherapy boost, including when to choose an interstitial implant rather than a cylinder. By the end, you will be able to choose the correct nodal basins based on tumor location, justify definitive radiation over morbid surgery, and construct a curative EBRT and brachy plan to seventy to eighty-five gray with the right applicator for the residual tumor thickness.

Last time we built the algorithm for early vulvar cancer—who needs nodes, how sentinel mapping changes the plan, and when to radiate the vulvar bed and groins. Today we turn to the hard one: locally advanced, unresectable disease. We’ll start by defining “unresectable,” walk through the neoadjuvant chemoradiation evidence, and then do a planning workshop you can take straight to clinic: how to contour the inguinofemoral basins without the classic medial miss, how to set doses for elective versus high-risk volumes, and why you should not “midline-block” the vulva when you’re treating positive nodes. We’ll reinforce, repeat where it helps, and keep it board-ready.

This is Episode twelve: Vulvar Cancer Part one—Foundations and evidence for surgery and adjuvant radiation. Today we build from first principles—epidemiology, pathophysiology, anatomy, workup, and staging—and then walk the decision tree for surgery, nodes, and radiation using four anchor studies: the depth-of-invasion rule from the GOG era, the GROINSS-V pathway for sentinel nodes, the Heaps margin criteria for the primary, and GOG-thirty-seven for node-positive adjuvant radiation. By the end, you’ll know when to observe, when to re-operate, and when—exactly—to radiate the vulva, groins, and pelvis.