Staff Publication

Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial (2014)

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Type of publication:
Randomised Controlled Trial

Author(s):
Dutton SJ,Ferry DR,Blazeby JM,Abbas H,Dahle-Smith A,Mansoor W,Thompson J,Harrison M,*Chatterjee A,Falk S,Garcia-Alonso A,Fyfe DW,Hubner RA,Gamble T,Peachey L,Davoudianfar M,Pearson SR,Julier P,Jankowski J,Kerr R,Petty RD

Citation:
Lancet Oncology, 07 2014, vol./is. 15/8(894-904), 1470-2045;1474-5488 (2014 Jul)

Abstract:
BACKGROUND: Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer.METHODS: For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0-2, and with measurable or evaluable disease on CT scan. Participants were recruited from 48 UK centres and randomly assigned (1:1) to gefitinib (500 mg) or matching placebo by simple randomisation with no stratification factors. Patients, clinicians, and trial office staff were masked to treatment allocation. Treatment continued until disease progression, unacceptable toxicity, or patient choice. The primary outcome was overall survival, analysed by intention to treat. This trial is registered, number ISRCTN29580179.FINDINGS: Between March 30, 2009, and Nov 18, 2011, 450 patients were randomly assigned to treatment groups (one patient withdrew consent; 224 patients allocated gefitinib and 225 allocated placebo included in analyses). Overall survival did not differ between groups (median 373 months, 95% CI 323-450, for gefitinib vs 367 months, 95% CI 297-437, for placebo; hazard ratio 090, 95% CI 074-109, p=029). Among the prespecified patient-reported outcomes (110 patients on gefitinib and 121 on placebo completed both baseline and 4 week questionnaires and were included in analyses), odynophagia was significantly better in the gefitinib group (adjusted mean difference -861, 95% CI -1449 to -273; n=227; p=0004), whereas the other outcomes were not significantly improved compared with placebo: global quality of life (269, 95% CI -233 to 772, n=231, p=0293), dysphagia (-318, 95% CI -836 to 200, n=231, p=0228), and eating (-411, 95% CI -996 to 175, n=229, p=0168). Median progression-free survival was marginally longer with gefitinib than it was with placebo (157 months, 95% CI 123-190 in the gefitinib group vs 117 months, 95% CI 107-137 in the placebo group; HR 080, 95% CI 066-096, p=0020). The most common toxicities were diarrhoea (36 [16%] of 224 patients on gefitinib vs six [3%] of 225 on placebo) and skin toxicity (46 [21%] vs two [1%]), both mostly grade 2. The commonest grade 3-4 toxicities were fatigue (24 [11%] vs 13 [6%] patients) and diarrhoea (13 [6%] vs two [1%]). Serious adverse events were reported in 109 (49%) of 224 patients assigned to gefitinib and 101 (45%) of 225 on placebo. 54 (24%) of patients in the gefitinib group achieved disease control at 8 weeks, as did 35 (16%) of patients on placebo (p=0023).INTERPRETATION: The use of gefitinib as a second-line treatment in oesophageal cancer in unselected patients does not improve overall survival, but has palliative benefits in a subgroup of these difficult-to-treat patients with short life expectancy. Future research should focus on identification of predictive biomarkers to identify this subgroup of benefiting patients.FUNDING: Cancer Research UK. Copyright 2014 Elsevier Ltd. All rights reserved.

Link to more details or full-text: http://www.sciencedirect.com/science/article/pii/S1470204514700245

 

Brachialis muscle tendon insertion avulsion fracture in a 6-year-old child (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Mbah CA, *Hussain A, *Turner R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 6-year-old boy, who fell while playing at school, presented to the fracture clinic with a suspected right distal radius fracture. On examination, the child was tender over the dorsal aspect of the distal radius and also had pain and stiffness around the elbow joint with a lack of the last 25° of elbow flexion. An acute haemarthrosis was also suspected at presentation. Plain anteroposterior (AP) and lateral radiographs of the elbow joint revealed an abnormal calcification superimposed on the anterior aspect of the coronoid process (figure 1A, B), which had not been visualised on plain radiographs in A&E.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202420.extract

 

Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). (2014)

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Type of publication:
Journal article

Author(s):
*Chandra A, *Clarke R, *Shawkat H

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202864.abstract

 

A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy (2014)

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Type of publication:
Journal article

Author(s):
*Moores KL, *Wood MG, *Foon RP

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation. Emergency caesarean section was performed and the 180degree uterine torsion was diagnosed intraoperatively. Posterior hysterotomy was required for delivery prior to detorsion of the uterus. This report describes that prompt recognition and intraoperative vigilance can achieve a successful maternal and fetal outcome in this rare and difficult obstetric scenario.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202974.abstract

Chest pain with raised troponin, ECG changes but normal coronary arteries (2014)

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Type of publication:
Journal article

Author(s):
*Amjad A,  *Ali A, *Bashir A,  *Ali M,  *Azam MN

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered.

Link to more details:

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-201975.abstract

 

Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries (2014)

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Type of publication:
Journal article

Author(s):
*Singh R, *Manoharan G, *Moores TS, *Patel A

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achilles tendon rupture in a 46-year-old man. There have been no previous reports of Achilles tendon rupture with Nintendo Wii usage; it is a relatively uncommon mode of injury and is rare in terms of epidemiology of motion sensing video game injuries. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-202657.abstract

 

Primary uterine osteosarcoma presenting synchronously with bilateral breast carcinomas (2014)

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Type of publication:
Journal article

Author(s):
*Powell G, Barth L, Todd R, Ganesan R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Primary uterine sarcomas are infrequent neoplasms and most commonly leiomyosarcomas or endometrial stromal sarcomas. We report a rare case of primary uterine osteosarcoma discovered in a woman in her 60s following staging CT imaging for bilateral breast carcinomas. Examination of the subsequent hysterectomy specimen showed a tumour composed of malignant spindle cells and osteoclast-like giant cells associated with osteoid and neoplastic bone, in keeping with primary uterine osteosarcoma. Distinction of osteosarcoma from the more common carcinosarcoma is important due to the worse prognosis impacting on treatment decisions. In addition, synchronous presentation of this unusual tumour with bilateral breast carcinomas raises the possibility of a mutual genetic pathogenesis. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://bmj-casereports.highwire.org/content/2014/bcr-2013-201502.abstract

Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: is it common? (2014)

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Type of publication:
Journal article

Author(s):
Mohammed I, *Zaatari MS, Tyrogalas N, Khalid MI

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction. The patient was completely well, stable and asymptomatic and he was rushed immediately to the coronary care unit via emergency ambulance. The patient was subjected to a battery of urgent investigations which were all normal. Also an urgent coronary angiogram was undertaken which showed completely normal coronary anatomy. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-202586.abstract