RadOnc Smart Review

This is Episode 13: Bladder Cancer – Non-Muscle-Invasive and Muscle-Invasive Workup and the Surgical Backbone. Here's why this episode matters: Bladder cancer is a disease where radiation oncologists can be indispensable members of a curative bladder-preservation team, or completely absent from meaningful treatment discussions. The difference often comes down to understanding the surgical and medical backbone of the disease. You cannot intelligently argue for trimodality therapy in a tumor board if you don't understand what a quality TURBT looks like, when repeat TURBT is needed, what cisplatin-based perioperative therapy aims to achieve, and which patients benefit most from radical cystectomy.

This is Episode 11: Prostate Follow-up, Toxicity, Survivorship, and Failure Patterns. This is a high-yield episode because most prostate teaching focuses on the front end: risk stratification, dose, fractionation, and ADT duration. However, in the real clinic, a huge share of what you do is follow-up. You will spend more time interpreting PSA trends, counseling men about late effects, and managing survivorship than you ever spent simulating the original plan.

This is Episode 10: Prostate Planning Workshop intact, post-op, and nodal cases. For the last several episodes, we've discussed what to treat in prostate cancer – risk groups, ADT duration, brachy boost candidates, and salvage triggers. Today, we're flipping the camera around and talking about how you actually deliver that plan. This is the episode where we sit down at the contouring station together.

Welcome back to Rad Onc Smart Review, Genitourinary Oncology edition. This is Episode 9: a discussion on prostate cancer across the metastatic continuum, including metastatic hormone-sensitive disease, nonmetastatic castration-resistant disease, metastatic castration-resistant disease, metastasis-directed therapy, and precision systemic therapy. We'll cover how to move from localized to advanced disease by defining the disease state, the burden, and how biomarkers impact management.

Episodes 3 through 7 covered definitive treatment. This episode covers what to do when definitive treatment fails. After prostatectomy, earlier salvage RT at lower PSA is associated with better outcomes. After prior RT or focal therapy, salvage can still be curative in selected patients, but it requires careful restaging and biopsy confirmation before local retreatment. Today we will cover four things: the shift from routine adjuvant RT to early salvage RT after prostatectomy, the selective role of ADT and pelvic nodal coverage in the salvage setting, the workup for recurrence after RT or focal therapy, and the major salvage options for radiorecurrent disease.

The first three episodes established the foundation – anatomy, risk groups, workup, and surveillance. Now, we begin treatment. This episode explores the physics and biology of dose delivery to the prostate. We'll cover three key areas: First, the benefits of higher doses for biochemical control and what long-term data reveals about distant metastasis and cancer-specific mortality. Second, the rise of moderate hypofractionation as the standard of care, including supporting trials, radiobiologic principles, and important toxicity signals. Third, the FLAME concept – boosting the MRI-visible dominant lesion – and the importance of prioritizing OAR constraints.

E07 Draft

E06 draft

E05 draft

Episode 3 draft