Editorial: The society for environmental geochemistry and health (SEGH): 50 years and beyond

When the SEGH international board released a short editorial paper back in 2019, we described an aim to increase the membership offering, whilst improving the diversity of input regionally, by scientific discipline and to ensure greater and more regular contact across the regions from 2020 onwards. Wider aspirations described in 2019 (Watts et al. 2019) are discussed within this short communication at the end of 2021 to evaluate progress made. In particular, how the SEGH community adapted to the unprecedented circumstances that have challenged each and every one of us throughout the COVID-19 pandemic since early 2020 and are likely to influence our activities for the foreseeable future.

Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres

AIM

Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009.

MATERIALS AND METHODS

UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance.

RESULTS

In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity.

CONCLUSION

In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.

Afatinib use in non-small cell lung cancer previously sensitive to epidermal growth factor receptor inhibitors: the United Kingdom Named Patient Programme

INTRODUCTION

Afatinib prolongs progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC) who were previously sensitive to erlotinib or gefitinib. This study investigated experience of afatinib under a Named Patient Use (NPU) programme.

PATIENTS AND METHODS

Retrospective data for 63 patients were collected, including demographics, dose, toxicity and clinical efficacy.

RESULTS

Response rate and median PFS were 14.3% and 2.6months, respectively. Diarrhoea and rash were the most common toxicities; 46% of patients required a dose reduction and 41% had a dose delay.

CONCLUSIONS

Efficacy and safety in the NPU programme are consistent with the LUX-Lung 1 trial.

Arsenic speciation in polychaetes (Annelida) and sediments from the intertidal mudflat of Sundarban mangrove wetland, India

This paper documents the concentration of total arsenic and individual arsenic species in four soft-bottom benthic polychaetes (Perenereis cultifera, Ganganereis sootai, Lumbrinereis notocirrata and Dendronereis arborifera) along with host sediments from Sundarban mangrove wetland, India. An additional six sites were considered exclusively for surface sediments for this purpose. Polychaetes were collected along with the host sediments and measured for their total arsenic content using inductively coupled plasma mass spectrometry. Arsenic concentrations in polychaete body tissues varied greatly, suggesting species-specific characteristics and inherent peculiarities in arsenic metabolism. Arsenic was generally present in polychaetes as arsenate (As(V) ranges from 0.16 to 0.50 mg kg(-1)) or arsenite (As(III) ranges from 0.10 to 0.41 mg kg(-1)) (30-53 % as inorganic As) and dimethylarsinic acid (DMA(V) <1-25 %). Arsenobetaine (AB < 16 %), and PO(4)-arsenoriboside (8-48 %) were also detected as minor constituents, whilst monomethylarsonic acid (MA(V)) was not detected in any of the polychaetes. The highest total As (14.7 mg kg(-1) dry wt) was observed in the polychaete D. arborifera collected from the vicinity of a sewage outfall in which the majority of As was present as an uncharacterised compound (10.3 mg kg(-1) dry wt) eluted prior to AB. Host sediments ranged from 2.5 to 10.4 mg kg(-1) of total As. This work supports the importance of speciation analysis of As, because of the ubiquitous occurrence of this metalloid in the environment, and its variable toxicity depending on chemical form. It is also the first work to report the composition of As species in polychaetes from the Indian Sundarban wetlands.

Segmental bony reconstruction of the thumb by composite groin flap: a case report

The use of a pedicled, osteocutaneous groin flap to reconstruct a composite, interpositional loss of tissue in the thumb is reported. The bone is transferred as a living segment, not a dying graft, and hence affords the rapidity and strength of primary bony union.

Epitheloid sarcoma: a case report

Epitheloid sarcoma of the pulp of the thumb followed repeated penetrating injuries to the digit. It was treated aggressively and successfully to date, nearly 5 years later. In some respects this case report parallels those animal experiments in which foreign body tumorigenesis has been demonstrated, and one might entertain a correlation.