RadOnc Smart Review

Today is a hands-on planning workshop. We’ll simulate, contour, and plan adjuvant pelvic IMRT. Then we’ll master vaginal cuff HDR brachytherapy—from choosing the cylinder to writing the prescription and optimizing dwell times. You’ll also get two short “oral boards canned speeches” you can deliver verbatim on exam day.

Welcome back to Rad Onc Smart Review, Gyn cancer series. This is a special topics episode focused on three areas that trip people up on consults and in orals: uterine sarcomas, carcinosarcoma, and how to cure medically inoperable endometrial cancer with radiation.

This is Episode ten: Endometrial Cancer, Part three — high-risk histologies and Stage three through four-A disease, plus what to do when cancer comes back.Last time we mastered adjuvant therapy for early stage. Today we zoom in on who truly benefits from chemo-radiation, how to reconcile Portec-three with G.O.G. two fifty-eight, how molecular subtype changes the plan, and what first-line therapy looks like now for advanced or recurrent disease.

Last time, we mastered modern staging and SLN mapping. Today, we answer the question you get every week in clinic: Who needs observation, who gets VBT, and who still needs pelvic EBRT? We’ll build the algorithm from GOG 99, PORTEC-1, PORTEC-2, and key updates, and we’ll start with a quick Surgical Corner so we’re crystal-clear on what operation and pathology we’re planning around.

Today we pivot from cervical to endometrial cancer, the most common gynecologic malignancy in the U.S. While many patients present early, outcomes hinge on understanding the biology and the new 2023 FIGO staging that integrates molecular data. We’ll differentiate classic and molecular subtypes, walk the new staging system, and review why sentinel lymph node biopsy (SLNB) is now the standard for nodal staging.

For two decades, concurrent cisplatin-based chemoradiation was the uncontested standard for locally advanced cervix cancer. That foundation still stands—but 2023–2024 ushered in real upgrades. Today, we’ll cover what to add (and when) for definitive therapy, and how first-line systemic therapy has changed for metastatic and recurrent disease.

In our last episode, we established why brachytherapy is a mandatory, life-saving component of definitive cervical cancer treatment. Today, we get practical. This is a hands-on workshop covering the "how-to" of brachytherapy. We will walk through the key steps of a tandem and ovoids procedure, learn how to decide when to add interstitial needles, and most importantly, master the dose constraints—the "cheat sheet" of numbers that you absolutely must know to create a safe and effective plan.

In our last episode, we mastered the modern techniques for planning pelvic external beam radiation. But for the definitive treatment of cervical cancer, EBRT is only the first half of the story. The second, non-negotiable component for achieving a cure is brachytherapy. Today, we’re going to build the case for why brachytherapy is mandatory. We’ll review the powerful evidence demonstrating its survival benefit over external-beam boosts, the critical importance of overall treatment time, and the paradigm shift toward image-guided volumetric targets that has transformed outcomes.

In our last few episodes, we’ve focused on the “why” and “when” of treating cervical cancer. Today, we shift to the “how.” This is a practical, hands-on workshop: how to simulate, contour pelvic and para-aortic nodes with modern atlases, justify IMRT over 3D, choose an SIB for nodal disease, execute IGRT correctly, and manage toxicities proactively.

Today, we are tackling one of the most significant paradigm shifts in the history of radiation oncology: the establishment of concurrent chemoradiation as the definitive standard of care for locally advanced cervical cancer. This isn't just an incremental improvement; it was a revolution that dramatically improved survival for our patients. Understanding the key trials that drove this change is absolutely essential for both your clinical practice and your board exams.