RadOnc Smart Review

This is one of the highest-yield modern RCC topics because it sits right where three practice changes collide. First, RCC was long treated as a disease that did not respond well to conventional radiation, but modern ablative radiation changed that conversation. Second, cytoreductive nephrectomy went from reflex dogma to a selective, risk-adapted decision. Third, immune checkpoint inhibitor–based combinations became the backbone of first-line metastatic therapy, which means local therapy now has to be placed carefully and honestly into the treatment sequence.

This is Episode 24: Renal Cell Carcinoma Localized Disease, Surgery, Ablation, and Primary SBRT. Here is the modern frame. Localized RCC is still primarily a surgical disease. Conventional fractionation never established a curative or adjuvant role in this setting. But stereotactic ablative body radiotherapy has changed the conversation for selected patients who are medically inoperable, technically high risk for surgery, or who decline surgery.

This episode is about what happens after cure. Testicular cancer is one of the great success stories in oncology, but that success creates a second job: taking care of survivors for decades. These are often young men with excellent cure rates and long life expectancy. So the real question is not just whether you cured the cancer. It is whether you protected fertility, recognized relapse on the right schedule, and minimized the long-term cost of treatment.

This is the episode where testicular cancer stops being mostly about stage I and stage II decision trees and starts becoming a sequencing problem. The questions are no longer just surveillance versus adjuvant therapy. Now the important questions are: how do you classify risk correctly, which chemotherapy backbone belongs to which group, when does PET help, when does it not help at all, who needs surgery after chemotherapy, and what exactly do you do when the disease comes back.

This is Episode 20: Testicular Stage II Seminoma, NSGCT, and Field Design. Last episode, we built the foundation: markers, orchiectomy, staging, and why surveillance is preferred for most stage I seminoma. Today we move into stage II disease, where the question is no longer just whether you know the basics. The question is whether you can choose treatment, explain why, and, if needed, describe a radiation field clearly and defensibly.

This is Episode 19: Testicular Cancer - Workup, Markers, Staging, and Stage I Seminoma. Testicular cancer is uncommon overall, but it is the most common solid malignancy in young men, and it is one of the great cure stories in oncology. That changes the way we think about treatment. The question is often not whether cure is possible. The question is how to preserve cure while minimizing overtreatment and long-term toxicity in a patient who may live for decades.

This is Episode 17: metastatic urothelial cancer, immunotherapy, and future directions. This is one of the fastest-moving areas in GU oncology. For years, first-line treatment for metastatic urothelial cancer meant platinum-based chemotherapy, with median overall survival in the mid-teens. That changed with EV-302. For many patients, the preferred first-line regimen is now enfortumab vedotin plus pembrolizumab. This is a major practice shift and is absolutely board-relevant.

This is Episode 16: Bladder Post-Cystectomy Radiation, Follow-Up, and Salvage Pathways. This episode is high-yield because it addresses two common bladder cancer mistakes. First, it corrects the simplistic answer that radiation has no role after cystectomy. Second, it clarifies the need to act promptly when a patient, previously treated with trimodality therapy, experiences an invasive recurrence. In modern board-style teaching, this episode covers selective postoperative radiation for high-risk pathology and the importance of recognizing when salvage cystectomy is necessary.

This is Episode 15: Bladder Planning Workshop - Definitive Preservation Cases. The last episode focused on who qualifies for trimodality therapy and why concurrent chemoradiation is preferred over radiation alone. Today's planning episode covers how to simulate, contour, choose volumes, and make technically defensible decisions when the bladder is moving, deforming, and sitting right next to the small bowel.

This is Episode 14: Bladder Trimodality Therapy, Radiosensitizers, and Hypofractionation. Here's the key takeaway: bladder-preserving trimodality therapy is a viable curative option, not a last resort. In the right patients, it's a legitimate strategy, deserving of discussion alongside radical cystectomy. To excel on exams, present it correctly: prioritize candidate selection, use concurrent radiosensitizers, and incorporate salvage planning from the outset.