RadOnc Smart Review

Episode 10: Resectable and Borderline-Resectable Pancreas: Perioperative Strategy.Choosing surgery first or preoperative therapy in pancreatic cancer requires more than a resectability label. In this episode, we compare clearly resectable and borderline-resectable pathways, review adjuvant evidence and the PREOPANC, PREOPANC-2, and A021501 trials, and examine response assessment, selective radiation, and the path to surgery.

Episode 9: Pancreatic Cancer: Workup, Anatomy, Staging, and Resectability.Pancreatic cancer needs both an anatomic stage and a clear description of resectability. In this episode, we follow a pancreatic-head presentation through diagnosis, imaging, obstruction management, surgical anatomy, and AJCC staging. We then examine how vessel contact, reconstructibility, tumor biology, and patient fitness shape a reproducible multidisciplinary assessment.

Episode 8: Metastatic Gastric and GEJ Cancer: Biomarkers, Systemic Therapy, and Palliation.Metastatic gastric and GEJ cancer requires a treatment plan built around symptoms, fitness, goals, and biomarkers. In this episode, we review tissue assessment and the HER2, PD-L1, mismatch-repair, and claudin 18.2 dashboard, explore first-line and progression decisions, and connect systemic therapy with local palliation and supportive care.

Episode 7: Gastric Radiation: Indications, Evidence, and Treatment Planning.Before planning gastric radiation, the team must define the local problem it is meant to address. In this episode, we examine the indications and trial evidence in the context of surgical quality, margins, and systemic therapy, then work through preoperative and postoperative target decisions, nonoperative care, and symptom relief.

Episode 6: Gastric Cancer Foundations: Staging, Surgery, and Perioperative Therapy.A gastric cancer treatment plan begins with the primary site, complete staging, surgical feasibility, and the patient's ability to complete multimodality care. In this episode, we follow an antral cancer case through pathology, staging, gastrectomy and D2 surgery, perioperative evidence including FLOT and MATTERHORN, biomarker assessment, and reassessment before the next treatment step.

Episode 5: Adjuvant Therapy, Active Surveillance, and Advanced Esophageal Cancer.A good response to treatment can lead to very different next steps in esophageal cancer. In this episode, we distinguish adjuvant therapy after resection, active surveillance after a carefully assessed clinical response, and treatment of advanced disease. We review CheckMate 577, SANO, biomarker interpretation, and symptom-directed local care in their specific clinical settings.

Episode 4: Definitive Esophageal Chemoradiation: Dose, Technique, Response, and Salvage.Definitive chemoradiation requires a complete plan for patients with esophageal cancer who are not proceeding to surgery. In this episode, we work through patient selection, concurrent treatment, dose evidence, target definition, and normal-tissue protection, then connect toxicity management and response assessment to the possibility of salvage surgery.

Episode 3: Resectable Esophageal and GEJ Cancer: CROSS, FLOT, and Perioperative Selection. The modern approach to resectable esophageal cancer has evolved beyond simply asking if a patient needs preoperative treatment; for most locally advanced cancers, the answer is yes. In this episode, we dive into the more complex decision-making process: determining which preoperative strategy such as the CROSS or FLOT regimens best aligns with a patient's specific histology, tumor anatomy, risk profile, and surgical plan.

Episode 2: Esophageal and GEJ Cancer Anatomy, Workup, Staging, and Surgery. In this episode, we explore how esophageal cancer punishes imprecise anatomy. We discuss why a difference of just a few centimeters can fundamentally alter the primary site, staging schema, regional nodal map, operative approach, and the necessity for specialized airway or peritoneal staging procedures.

This is Episode one: G I Oncology Foundations, Workup, Intent, Planning Safety, and Cross Cutting Toxicity.The most dangerous G I oncology error is often not choosing the wrong dose. It is answering the dose question before proving the diagnosis, stage, treatment intent, and problem that radiation is supposed to solve.