.png)
Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
Stay sharp, stay current, and stay confident with Brilliant Medicine — the go-to podcast for Internal Medicine and Family Medicine physicians, residents, nurse practitioners, and physician assistants.
Each episode delivers high-yield insights on the latest breakthroughs, practice-changing guidelines, and cutting-edge treatments in Internal Medicine — with just enough board review to keep your clinical reasoning razor-sharp.
We cut through the noise, simplify complex studies, and translate new data into actionable knowledge for your daily practice. Whether you're prepping for boards or staying ahead in clinic, hospital, or telemed — we've got your back.
🩺 Fast. Practical. Evidence-based.
This is the update your medical brain craves.
Brilliant Board Review & CME
🎙️ Episode 26: Radiation Optional? Rethinking Esophageal Cancer Pre-Op
🧪 The EPOC Trial:
Compared FLOT chemotherapy alone vs chemo + radiation before surgery in localized esophageal/gastroesophageal adenocarcinoma.
📈 Findings:
FLOT alone led to better 3-year progression-free survival: 51.6% vs 35%.
No survival benefit from adding radiation.
Patients receiving FLOT alone had fewer complications, improved tolerance, and less treatment-related morbidity.
🧩 Clinical Takeaway:
For operable esophageal adenocarcinoma, skip the radiation if you're doing full-dose chemo.
Less burden for patients, especially elderly or frail.
Now let's talk about preoperative chemoradiotherapy for resectable esophageal carcinoma. So adding radiation therapy in the preoperative treatment of gastroesophageal adenocarcinoma resulted in no survival benefit over chemotherapy alone. Why is this important? Well, just think about, if you're a patient, first of all, the side effects of gut irradiation, but also, is your life going well when you have esophageal carcinoma? You're probably not going to be eating well, you're probably not getting great nutrition, and just think you have to get somebody to drive you to get this radiation therapy. You have to be able to get the radiation therapy. You've seen patients who've undergone radiation therapy. Is their life great at that moment? No, it sucks. So this is an opportunity to reduce pain and suffering for patients.
Speaker 1:So this is in patients, the ESOPEC trial, we'll call it that Patients with esophageal or gasoesophageal junction endocarcinoma. So they had two arms one where they see float chemotherapy, which is fluoruracil, lucavorn, oxaliplatin or dosotaxel part of the float chemotherapy, or perioperative chemoradiotherapy with carboplatin, paxitaxel and radiotherapy. Now what they measured is a progression-free survival of three years with flow was superior to chemo radiotherapy with no new safety signals, and the progression-free survival was pretty significant. The flow compared to the chemo radiotherapy was 51.6% to 35% progression-free survival of three years and the pathological. The tissue response was 12.7% versus 10.1%. So big breakthrough for resectable esophageal carcinoma in the perioperative and preoperative treatment levels.