MRI-guided Radiation Therapy (MRgRT), FLASH proton therapy, concurrent immunotherapy, and radiation therapy and SBRT for oligometastatic disease, are emerging technologies and approaches to optimize cancer care.

Patients with Stage IV Lung cancer vary in their response to the numerous systemic therapies and are living longer. The role of aggressive local therapy or metastatic directed therapy (MDT) is critical for radiation oncologists and surgeons.

Over the last 10 years, new studies have emerged demonstrating efficacy and safety of re-irradiation for children with recurrent brain tumors.

Bone sarcomas are routinely diagnosed in the adolescent and young adult population.

Given the rate of scientific advances over the past 20 years, it is difficult for practicing radiation oncologists to stay abreast of the latest drugs, their targets and mechanisms of action.

The use of SABR is well established in many cancers, however, its application within kidney cancer is relatively new. This is largely due to the historical notion that renal cell carcinoma (RCC) is highly radioresistant.

SBRT for oligometastatic disease of mixed histologies has been shown to improve progression-free and even overall survival. A large cooperative group study recently demonstrated that there was no overall survival advantage seen when constrained to breast cancer alone.

HyTEC (Hypo-fractionated or “Hy”-dose per fraction, Treatment Effects in the Clinic) was an American Association of Physicists in Medicine-led initiative focusing on hypofractionated SBRT/SABR and stereotactic radiosurgery in adults.

When implementing newer technologies practices often rely on vendor training, an evaluation of published literature, and collaboration with others experienced in the technology. Incident learning has a critical role in radiation therapy and may be most important in new and emerging technologies.

Anal cancer rates are increasing, and there is a need to improve coordination across the spectrum of anal cancer care, from diagnosis, treatment, recovery and survivorship. Failure to understand the roles of all the multidisciplinary aspects of care leads to suboptimal patient care.