RadOnc Smart Review

Episode 20: Rare GI Malignancies: Small Bowel, Duodenum, Appendix, GIST, and Neuroendocrine Tumors.Rare gastrointestinal malignancies do not share a single treatment pathway. In this episode, we distinguish small bowel and duodenal cancers, appendiceal tumors, GIST, and neuroendocrine neoplasms, using histology, grade, differentiation, site, and stage to organize management and place radiation in the appropriate disease-specific context.

Episode 19: Colorectal Oligometastases: Liver and Lung Surgery, Ablation, SBRT, and COLLISION.Choosing a local treatment for colorectal liver or lung metastases starts with whether complete clearance is feasible. In this episode, we compare the roles of surgery, ablation, and SBRT within multidisciplinary care, examine the COLLISION evidence, and discuss how disease distribution and systemic treatment shape the local-treatment decision.

Episode 18: Metastatic Colorectal Cancer: Molecular Selection and Systemic Therapy.A first-line metastatic colorectal cancer plan needs a complete molecular and clinical picture. In this episode, we examine mismatch repair, RAS, BRAF, HER2, other actionable alterations, and primary sidedness, then connect those findings with systemic treatment selection, disease tempo, resectability, symptoms, and the patient's goals.

Episode 17: Localized Colon Cancer: Staging, Surgery, Adjuvant Therapy, and the Limited Role of Radiation.After colon cancer surgery, the next step depends on stage, pathologic risk, mismatch-repair status, and the precise site of the primary. In this episode, we review staging, surgery, and adjuvant therapy, then define the limited circumstances in which radiation enters the discussion and the questions that should guide a postoperative recommendation.

Episode 16: Advanced Biliary Tract Cancer: Systemic Therapy, Biomarkers, and Local Therapy.Advanced biliary tract cancer care must bring urgent biliary problems, systemic treatment, and molecular profiling into the same plan. In this episode, we examine anatomic subtype, obstruction and infection, first-line therapy, biomarker-directed options, and the selective use of local treatment, with attention to sequencing and patient goals.

Episode 15: Resectable Biliary Tract Cancer: Surgery, Adjuvant Therapy, and Radiation.A postoperative biliary cancer referral needs more detail than a diagnosis and a positive-margin label. In this episode, we connect anatomic subtype, the operation, pathology, and recurrence risk to adjuvant treatment decisions, exploring the evidence and the role of radiation within a multidisciplinary plan.

Episode 14: HCC Radiation: EBRT, SBRT, Protons, Planning, and Integration.Radiation for HCC requires a clear local-treatment goal and careful protection of the remaining liver. In this episode, we examine EBRT, SBRT, protons, and their integration with other therapies, review comparative evidence including RTOG 1112, and work through prescription, biliary and luminal risks, and a practical planning case.

Episode 13: HCC Foundations: Diagnosis, Liver Function, Staging, and Multidisciplinary Selection.An HCC treatment decision depends on both the cancer and the liver that must tolerate treatment. In this episode, we work through diagnosis, liver reserve, portal hypertension, staging, and multidisciplinary selection, showing why these foundations need to be established before choosing a local or systemic treatment strategy.

Episode 12: Pancreas Planning Workshop: Simulation, Targets, Motion, and Constraints.A pancreatic radiation prescription must fit the patient's anatomy and the motion seen at simulation. In this planning workshop, we work through simulation, image registration, target definition, respiratory motion, and organ-at-risk constraints. The discussion connects technical choices with treatment safety when the tumor lies close to the duodenum and other sensitive structures.

Episode 11: Locally Advanced Pancreas: Chemotherapy, Chemoradiation, SBRT, and Adaptation.For a patient with locally advanced pancreatic cancer, treatment goals and the limits of each modality need to be clear from the start. In this episode, we examine systemic therapy, chemoradiation, SBRT, and adaptation, with attention to patient selection, local control, symptoms, and reassessment of surgical possibilities.