Radiation oncology emergencies are a critical domain where timely recognition and decisive intervention influence patient outcomes considerably. This chapter synthesizes practical, experience-driven approaches to the acute presentations most frequently encountered in oncologic care, more specifically in radiation oncology setting. Malignant spinal cord compression, superior vena cava syndrome, uncontrolled tumor bleeding, airway compromise, and symptomatic brain metastases represent the core entities addressed, each demanding rapid assessment, multidisciplinary coordination, and an individualized radiotherapeutic strategy. The chapter equips trainees and practicing oncologists with a clear, experience-informed framework to navigate emergencies confidently, ensuring prompt and effective care.