Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 37: Salivary Gland Four – Unresectable Disease and Advanced Approaches. This episode completes our Salivary Gland block. We have built the foundation – histology-driven biology in Episode 34, adjuvant R-T triggers and planning in Episode 35, and perineural invasion strategy in Episode 36. Today we address difficult cases: the patient who cannot undergo surgery, the tumor that recurs despite our best efforts, and the adenoid cystic carcinoma that metastasizes to the lungs years after we thought we had won. We will also cover a rapidly evolving area – biomarker-driven systemic therapy. This is where salivary gland oncology is changing fastest, and the board examiners know it.

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 36: Salivary Gland Three — Perineural Invasion and Named Nerve Strategy. Perineural invasion is the defining challenge of salivary gland radiation oncology. It is why adenoid cystic carcinoma behaves differently from mucoepidermoid. This is why some tumors recur at the skull base years after treatment. And it is absolutely a topic you will face on oral boards. Today, we build the complete framework for understanding, imaging, and treating perineural disease. By the end of this episode, you will be able to distinguish histologic P-N-I from clinical perineural tumor spread, trace the major nerve highways to their skull base foramina, and deliver a board-safe statement about when and how to extend your C-T-V tothe skull base.

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 35: Salivary Gland Two — Adjuvant RT Triggers and Planning. In Episode 34, we built the salivary gland paradigm: histology leads, surgery is primary, and adjuvant decisions are driven by risk factors that salivary tumors love to hide—especially perineural invasion and margin risk. Today is the bridge episode. We take our Episode 34 case back from the operating room and turn it into a board-safe, execution-ready postoperative plan. This is high-yield material for oral boards, where you will absolutely be asked to justify your P-O-R-T indications, define your target volumes, and defend your dose levels. By the end of this episode, you will be able to recite the complete P-O-R-T indication list with evidence citations, define the anatomic boundaries of the parotid surgical bed C-T-V, and explain exactly when and how to track the facial nerve in your target volumes.

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 34: Salivary Gland One — Histology-Driven Biology and the Surgical Paradigm. This episode launches our salivary gland block, and I want to be direct: salivary gland cancers are a board favorite because they force you to think differently. Unlike mucosal squamous cell carcinomas, where HPV status and TNM staging drive almost everything, salivary tumors require you to lead with histology. The histologic subtype tells you about local aggressiveness, perineural invasion risk, nodal behavior, and distant metastasis timing. Get the histology wrong, and your entire management framework collapses. Today, we establish the foundational paradigm: anatomy, histology diversity, why surgery is primary, how the facial nerve changes surgical decision-making, and an overview of when postoperative R-T enters the picture. This episode is high-yield for both written boards and oral examinations, where you will absolutely see a parotid mass with facial weakness and need to walk through the management algorithm.

This is Episode 33: Hypopharynx Integration Decision Points and Surveillance. Episode 31 covered the biology, including the worst-actor paradigm, prognosis, and the four defaults. Episodes 32 and 32b focused on planning: contouring, extension, and coverage. Now, we address the integration question: Who receives which treatment, and what does success look like? This episode explores decision-making. We'll discuss organ preservation, when to prioritize surgery, response assessment, salvage expectations, and the role of early palliative care.

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 32b: Hypopharynx Planning Workshop. Episode 32 gave you the rules, the four defaults, the nodal template, the inferior extent ladder, and the OAR priorities. Today, we build muscle memory. We're at the contouring workstation. Two complete cases. No new teaching pure application and narrated decision-making. Here's what I need from you: every time I state a default, say it back in your head. By the end of this workshop, those four defaults should fire automatically whenever you see a hypopharynx case.

In Episode 31, we established the foundational paradigm for hypopharyngeal cancer, the worst-actor subsite in head and neck oncology. We defined four defaults that govern our approach to these cases: Default one: retropharyngeal nodes on. Default two: bilateral neck on. Default three: inferior extent on. Default four: prognosis is brutal, plan accordingly. Today, we translate those defaults into actual treatment contours. This episode focuses on operationalizing principles into treatment plans that you can defend on oral boards and execute at the workstation.

This is Episode Thirty-One: Hypopharynx One — Anatomy, Prognosis, and the Worst-Actor Paradigm. Today we tackle the subsite that earns its reputation as the worst actor in head and neck oncology. Hypopharyngeal cancer presents late, spreads early, and hides submucosally—which means your default choices must be aggressive from the start. This episode is foundational. We will not contour a single structure today. What we will do is hard-wire the four defaults that will drive every planning and management decision in Episodes Thirty-Two and Thirty-Three.

Welcome back to Rad Onc Smart Review, Head and Neck edition. This is Episode 30: Larynx Capstone – Mock Oral Board Review. Today we simulate the oral boards exam in four clinical blocks. Each block features a case that escalates through workup, staging, treatment selection, planning priorities, and outcomes. We'll close each block with a twist testing a key decision pivot. Treat this like a live exam. After every question, you will hear: "Pause for listener to formulate response." Use that pause. Then compare your answer to the model response.

This episode, number 29, focuses on Advanced Larynx T4a and the Unpreservable. Building upon Episode 28's discussion of organ preservation, we explore instances where such preservation is not the optimal course of action. Specifically, we examine how to identify patients for whom maintaining the larynx is either impractical or detrimental. Given the natural inclination to offer preservation, this episode aims to equip listeners with the knowledge to counsel patients appropriately, whether advocating for preservation when suitable or recommending upfront laryngectomy when it is the more beneficial pathway. By the conclusion of this episode, listeners will possess a framework for recognizing the "unpreservable" patient and understanding the limitations of current landmark trials when applied to bulky T4a disease.