Soft Tissue Relapse Research Articles

Relapsed mantle cell lymphoma manifesting with soft tissue tumors of the extremities: University of Miami experience and review of the literature

Mantle cell lymphoma (MCL) is frequently diagnosed at advanced stages and is characterized by multiple extranodal sites of disease, most notably the bone marrow, peripheral blood, and gastrointestinal tract. Historically the prognosis of mantle cell lymphoma has been poor with median survival of four to five years. With new treatment regimens, however, patients have been able to achieve prolonged remissions and require special attention while being evaluated for relapse. This report describes four patients treated for stage IV mantle cell lymphoma at the University of Miami who developed soft tissue relapse presenting as non-tender large masses of the extremities, including one patient who presented without associated nodal involvement. Average time to soft tissue relapse was 99 months (range: 28–240) following initial diagnosis. Providers who care for patients with mantle cell lymphoma should be aware of soft tissue lesions as a presentation of mantle cell lymphoma that merits evaluation for disease relapse.

Evaluation of soft tissue profile changes following autogenous fat or onlay PEEK augmentation versus sliding genioplasty for correction of deficient chin: Randomized controlled clinical trial

AimThe study was conducted to evaluate soft tissue profile changes using autogenous fat augmentation or onlay PEEK versus sliding genioplasty for correction of deficient chin in patients with retruded chin. Material and methodsThirty-three patients with deficient chins were included in the study. The patients were distributed into 3 groups: the fat augmentation group as intervention I, the PEEK augmentation group as intervention II, and the osseous genioplasty group as control group. Preoperative and postoperative CBCT were performed for all patients. With the aid of MIMICS,3-MATIC, and PROPLAN software, diagnosis, virtual planning, and evaluation were performed. The Face-Q questionnaire was used to assess patient satisfaction. ResultsThere was a statistically significant difference regarding soft tissue relapse in the fat group after 6 months when compared to the control group (mean difference= 0.770), while there was no statistically significant difference regarding soft tissue relapse between PEEK and control group (mean difference= -0.060). Intragroup comparison has shown no statistically significant difference regarding soft tissue relapse within all groups between follow-up periods (P = 0.1389 for the fat group, P = 0.8739 for the peek group, and P = 0.8410 for the control group). All patients showed a statistically significant increase in scores of satisfaction with the chin between follow-up periods (P = 0.0165, P = 0.0150, and P = 0.0293) respectively. ConclusionsFat augmentation can be a good intervention choice in mild-moderate deficient cases. PEEK PSI has a stable surgical outcome.

Hard and Soft Tissue Relapse After Different Genioplasty Procedures: A Scoping Review.

The chin is a crucial component of facial aesthetics, and 20% of craniofacial problems require repair of the chin size, shape, and position. Genioplasty is used to treat irregularities in all three planes of the chin. Specific hard and soft tissue relapses following various genioplasty techniques have not been adequately studied in the literature to date. The purpose of this scoping review was to investigate the stability of hard and soft tissue changes achieved by different genioplasty procedures, six months after the procedure. A literature search was performed on PubMed, Web of Science, Embase, Wiley Online, Scopus, Google Scholar, Science Direct, and Cochrane databases from January 1, 2011to October 31, 2022. Prospective and retrospective cohorts, case-control studies, observational studies, and randomized control trials, with at least 10 patients, which were written in English and evaluated the stability of different genioplasty procedures, with a follow-up period of at least six monthswere included. The manual and electronic search yielded 523 articles, and after complete screening, seven articles were selected (five with advancement genioplasty and two with reduction genioplasty) that met the eligibility criteria for review. The patients undergoing reduction genioplasty had a mean age of 24.15 years, compared to 20.5 years for augmentation genioplasty. The average follow-up period was 18.64 months for augmentation genioplasty and 10.5 months for reduction genioplasty technique. The relapse was assessed at pogonion, and it was noted that the average surgical advancement at hard tissue pogonion was 7.04 mm with a relapse of 0.69 mm after six months post-treatment. The average vertical movement of the hard tissue pogonion was 1.8 mm with a relapse of 0.74 mm. The average reduction at hard tissue pogonion was 3.2 mm in the vertical direction with a relapse of 0.2 mm and 0.8 mm reduction in soft tissue pogonion with a relapse of 0.3 mm. The soft to hard tissue ratio mentioned in the different studies ranged from 0.89 to 0.97. Both reduction and augmentation genioplasty are stable and reliable for altering the chin position for aesthetic purposes. The recommended mode of fixation is rigid fixation.

Does suprahyoid muscle complex pull cause relapse following genial advancement by distraction osteogenesis? An electromyographic study

Active pull of the suprahyoid muscle complex (SMC) was thought to be the main contributor of relapse in mandibular or chin advancement, but literature evidence lacks human studies that assess the role of the SMC following genial advancement (GeA). This study therefore aimed to analyse the influence of SMC pull on relapse following GeA by distraction osteogenesis based on electromyographic (EMG) changes. EMG was recorded and analysed preoperatively (T0), at four months (T1), and at one-year follow up (T2) at three submental regions during two different activities. The outcome variables were EMG changes of the SMC, and hard and soft tissue relapse. Assessment was carried out by comparison of EMG and lateral cephalograms taken at T0, T1, and T2. Ten patients (7 male and 3 female; median (SD) age 21.2 (3.99) years, range 18-28) were included. The EMG values revealed a statistically significant reduction between T0 and T1. T2 values were not higher than T0 during any activity. The results of Pearson’s correlation demonstrated no significant relation between the amount of relapse and change in EMG values. This study concluded that active pull of the SMC is not the actual reason for skeletal relapse in chin or mandibular advancement. Passive biomechanics such as adnexial or muscular connective tissue, and paramandibular periosteum pull with native bone remodelling might be the prime reasons for relapse. However, further large sample studies are warranted to find the actual causes of relapse.

Evaluation of Sagittal Curving Osteotomy vs Conventional Advancement Genioplasty in Retrogenia Patients: a Randomized Control Trial.

With increasing aesthetic awareness, in addition to the forehead, nose, and cheekbone prominence, the chin nowadays is seen as one of the most important parts of the facial skeleton. Position of the chin has a strong influence on the assessment of the facial harmony; its different types and forms dominate the appearance. Furthermore, the expression of the chin is equated with character traits, and thus, it is an important component of the profile forms. Genioplasty is a routine procedure for the correction of aesthetic and functional deformity of the chin region. It is therefore one of the contour-enhancing surgical methods. The purpose of the present study is to study the versatility of sagittal curving osteotomy for advancement genioplasty as an alternative to conventional technique. A total of 24 subjects were enrolled for the study who were randomly distributed into two groups: group 1(n-12) comprising of patients in whom sagittal curving osteotomy was done and group 2 (n- 12) comprising of patients in whom conventional osteotomy was done. Neurosensory disturbances and hard and soft tissue relapse were compared between the two groups. On comparison of all the variables, it was found that the conventional osteotomy technique had more hard tissue relapse and more neurosensory disturbance as compared to sagittal curving osteotomy technique. Results of this study suggest that the use of sagittal curving osteotomy may be helpful in reducing postoperative neurosensory disturbances and relapses following genioplasty. Hence, it is recommended that sagittal curving osteotomy can be used as an alternative osteotomy technique for advancement genioplasty.

A critical appraisal of surgical outcomes following orbital hypertelorism correction: what is the incidence of true bony relapse versus soft tissue telecanthus?

Orbital hypertelorism (OHT) represents a congenital condition defined by lateralization of the bony orbit, unlike soft tissue telecanthus in which there is an increase in intercanthal distance without true bony lateralization. Existing literature remains very limited in its postoperative assessment of bony versus soft tissue relapse, which may both clinically present as telecanthus. We performed a critical appraisal of the literature to determine the postoperative incidence of bony versus soft tissue relapse following OHT repair. The PubMed, MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, and clinicaltrials.org were searched systematically for all English studies published in any time frame reporting relapse rates following primary OHT repair. The primary outcome was incidence of bony and soft tissue relapse defined as orbital lateralization and medial canthal drift, respectively. The secondary outcome measures include postoperative complications, predictors of postoperative complications, timing and type of surgery, and revision rates. Eleven articles were included. A total of 84 (35.3%) patients experienced bony relapse while 43 (27.2%) patients experienced soft tissue relapse. Age at time of intervention (p < 0.92), severity at presentation (p < 0.90), and surgical technique (p < 0.09) were not found be significantly associated with relapse rate. Methods for long-term follow-up were not standardized, and there was no consistent measure to objectively assess telecanthus. There is no general consensus on predictive factors of long-term relapse following OHT repair in the form of box osteotomy or facial bipartition. These findings call for cross-sectional outcome standardization to better understand long-term outcomes across institutional, provider, and patient differences.

Treatment of relapse/progression of the disease in patients with neuroblastoma in the Republic of Belarus over a 20-year period: a cohort study

Introduction. Neuroblastoma (NB) — is a malignant tumor of sympathetic nervous system in children. In our country there are about 50 % of patients in high risk group, 50 % have a relapse or a progression of the disease which is the main reason for their death. The purpose of the study . Our aim was to characterize a relapse/progression of NB in children in the Republic of Belarus, the analysis of results of treatment of patients from 1997 till 2017. Materials and methods . From October, 1997 to December, 2017 in Republican Scientific and Practical Center for Pediatric Oncology, Hematology and Immunology 293 protocol and observed patients received 1st line therapy. Out of them 73 patients had a progression or a relapse of the disease. This group of patients was taken for the analysis. Results. 14-year overal survival of patients with a relapse/progression of the disease was 21 + 6 % (n = 73), event free survival 18 + 5 % (n = 53). Patients older than 12 months at the time of diagnosis were statistically significantly more likely to recur, with 4th stage disease and having N-MYC amplification, diploid karyotype in the tumor. Adverse relapse options for localization are about 65 % (generalized — 41 %, osteomedullary — 12.3 %, relapses with CNS damage — 12.3 %). The most curable variants of relapses are found in 35 % (n = 25) of cases. In patients from the group of favorable and intermediate prognosis, relapses in the zone of primary tumor localization were significantly more frequent (p < 0.0001), bone loss in the relapse of the disease was significantly less common (p < 0.0001). The best results with the use of standard therapies are relapse with the primary tumor zone and soft tissue relapse (by 5 year relapse-free survival — 25% and 36 % respectively). Treatment of osteomedullary and generalized relapses using the methods available to us is not effective (EFS is 0). Conclusion. Further detailed study of the biology of the tumor is necessary, in order to create for the therapy of the disease targeted drugs and other biologically based approaches, such various types of immunotherapy.

Patterns of Local Failure after Radical Nephroureterectomy in Upper Tract Urothelial Carcinoma: Association with Primary Tumor Locations and Implications for the Clinical Target Volume Design of Adjuvant Radiation Therapy

There are no standards about the delineation of clinical target volume of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).This study aims to explore the high-risk local recurrence areas for UTUC patients stratified by primary tumor locations and in order to provide implications for the CTV design. All the UTUC patients who were followed up in our center after radical nephroureterectomy between 2010 and 2016 were retrospectively enrolled. The patterns of first discovered failure were assessed, and local recurrence sites (soft tissue relapse within the retroperitoneal field of exenteration and regional lymph nodes) were evaluated. All of the local recurrence sites were identified by MRI, CT, or PETCT. Three hundred twenty-nine patients with radical nephroureterectomy were enrolled in our study. The median follow up time was 45m (4-110m). Sixty-five patients experienced local recurrence. The median time from surgery to local relapse was 7m (range 1-48m). Local recurrence was the first event in 26 (57.8%) patients, the other 19 patients (42.2%) also had metastasis. We studied the detailed relapse site images of 45 patients. A total of 152 sites of local relapse were observed in 45 patients. The median relapse sites of each patient was 2 (1-10). The average number of positive nodes per patient was 3.4. Among the 152 relapse sites, lymphatic recurrence was the dominant recurrence type (90.1%, 137 sites), and the others were soft tissue recurrence (9.9%, 15 sites). We stratified all the patients into 3 groups according to their tumor location. Para-aorta lymph node region has the highest recurrence rates in all of the patients. The recurrence rates in this region account for 85% in renal pelvic and upper ureter tumor, 75% and 74% in middle and lower ureter tumor. The distribution of recurrent LN in middle and lower ureter tumors were much lower (below mid level of L2) than renal pelvic and upper ureter tumors (superior bonder of L1). Para-aorta recurrence in patients with left-sided UTUC almost occurred in LPA region. While the right-sided UTUC had higher para-aorta recurrence rate in RPC and AC region. Recurrence of internal and external iliac lymph node region was rare (<10%) in all the UTUC patients. In all of the soft tissue recurrence sites, the kidney fossa relapse accounted for 33.3% (5 sites); urecter tumor bed recurrence accounted for 66.7% (10 sites). Lymph node recurrences were the most common recurrence sites in UTUC patients after surgery. Para-aortic lymph node region was the common recurrence lymph regions in UTUC patients. Right-sided UTUC had different local relapse pattern compared with left-sided UTUC in this region. Recurrence in internal and external iliac lymph node region was rare (<10%) in all the UTUC patients. Delineate CTV according to the primary tumor locations can include more than 90% recurrence regions and decrease the radiation areas compared with conventional CTV.

Salvage rates after progression of high-risk neuroblastoma with a soft tissue mass

PurposeTreatment of progression in high-risk neuroblastoma remains challenging despite improved survival. We retrospectively evaluated outcomes in children with a first progression that included soft-tissue masses. MethodsWe reviewed records of 903 consecutive children with high-risk neuroblastoma diagnosed between 2004 and 2014, and identified 42 whose first progression included soft-tissue masses. Data on demographics, disease characteristics, treatment, and survival were collected. Primary outcome was 5-year overall survival (OS) from time of first progression. Secondary outcomes were local disease-free progression (LDFR) and progression-free survival (PFS) postprogression. We evaluated the prognostic significance of concomitant bone/bone marrow involvement, MYCN status, and multifocality of soft tissue relapse. ResultsMedian age at diagnosis was 3.0 (range: 1–10.7) years. Median time to first relapse or progression was 1.2 (range: 0.1–4.5) years after complete remission or minimal stable residual disease. Twelve (29%) patients had concomitant bone or marrow involvement at progression/relapse. There were 11 (26%) patients with International Neuroblastoma Staging System stage 3 disease (all with MYCN amplification), and 31 (74%) with stage 4 disease (12 with MYCN amplification). Nine (21%) patients had multifocal soft tissue progression. R1 resection was achieved in 41 children (95%), 38 (95%) of whom also received salvage radiation therapy. Five-year OS postprogression was 35% (95% CI: 19–51%), 5-year LDFS was 52% (95% CI: 32–72%), and 5-year PFS postprogression was 20% (95% CI: 6–34%). ConclusionAmong children with high-risk neuroblastoma who underwent aggressive treatment of a first soft-tissue recurrence, 5-year postprogression overall survival was 34%. Multifocality and MYCN amplification were the predominant prognostic correlates for worse survival.

Evaluation of Treatment Outcome in Cleft Maxillary Hypoplasia Treated by Rigid External Distractor

The aim of the study was to cephalometrically evaluate hard and soft tissue changes in cases of cleft-induced maxillary hypoplasia treated by distraction osteogenesis using rigid external distractor (RED). Fifteen cases of cleft-induced maxillary hypoplasia were selected applying the inclusion and exclusion criteria. The cases were operated on under general anesthesia for distraction osteogenesis using RED. Cephalometric evaluation was done at the end of presurgical orthodontics (C1), 1 week after removal of RED (C2), and at the end 12 months postoperatively (C3). The hard tissue parameters considered were Sella Nasion point A angle, Point A-Nasion-point B angle, distance from condylion to point A, anterior nasal spine-menton to Nasion-menton ratio, and upper incisor distance to N vertical. The soft tissue parameters included facial contour angle, nasolabial angle, upper lip to E-line, and lower lip to E-line. There were 8 males and 7 females with an average age of 13.07 years. The range of maxillary advancement was 8 to 24.5 mm with an average of 14.46 mm. The cephalometric data were compared using paired t test and 1-way analysis-of-variance test. All the hard tissue changes except SNB were statistically highly significant (P > 0.0001). The percentage of relapse was 13.72% at SNA, 13.3% at ANB, 9.83% for maxillary depth, 8.99% for distance of the upper incisor to N perpendicular and 20.73% for facial contour angle, 2.16% for nasolabial angle, 25.69% for distance of UL to E-line, and 25.12% for distance of LL to E-line. Soft tissue relapse except nasolabial angle after 1 year was more as compared with hard tissue. All the cephalometric parameters except SNB angle showed significant improvement. However, the significant percentage of relapse should be considered in the preoperative planning.

Long-Term Efficacy and Safety Outcomes of Modified (Simplified) MVAC (Methotrexate/Vinblastine/Doxorubicin/Cisplatin) as Frontline Therapy for Unresectable or Metastatic Urothelial Cancer

BackgroundThe classic MVAC (methotrexate/vinblastine/doxorubicin/cisplatin) regimen was the first recognized option for untreated patients with locally advanced or metastatic urothelial cancer (UC). Modifying MVAC by reducing side effects may have the potential to improve efficacy. Patients and MethodsChanges to classic MVAC were provided at the authors' institution: (1) deletion of day 22 and administration of 25 mg/m2 cisplatin on days 2 to 5 (modified [m]MVAC); (2) deletion of day 22 only (simplified [s]MVAC1); and (3) deletion of days 15 and 22 in a 3-week schedule (sMVAC2). A total of 4 to 6 cycles were provided. Multivariate analysis was undertaken for recognized clinical variables. ResultsFor the period from September 1986 to May 2012, 157 patients were identified (25 with mMVAC, 72 with sMVAC1, and 60 with sMVAC2). Overall, 43.9% had a Memorial Sloan-Kettering Cancer Center score of 1 or 2, with differences across series (P = .002). Altogether, 65.8% attained a complete (19.1%) or partial response (46.7%), and 24.3% a stable disease, with no difference across regimens. After a median follow-up of 87 months (interquartile range, 37-161), median progression-free survival was 10.2 months (95% CI, 8.4-10.8), and median overall survival (OS) was 19.5 months (95% CI, 16.3-24.1). Responses were mainly seen in nodal metastases or soft tissue relapse (odds ratio, 2.48; 95% CI, 1.12-5.54). Only visceral (hazard ratio [HR], 2.42; 95% CI, 1.37-4.30) and nodal metastases/local relapse (HR, 1.70; 95% CI, 1.07-2.69) were independently associated with OS. Grade 3 or 4 toxicities were similar across regimens and were 36% neutropenia, 14% thrombocytopenia, 12% anemia, 10% mucositis, and 4% renal toxicity. Two treatment-related deaths occurred. ConclusionSimplifying MVAC may result in improved efficacy and reduced toxicity. The combined results of the original and modified MVAC regimens encourage a reappraisal of the frontline management of advanced UC.

Stability of Soft Tissue Profile After Mandibular Setback in Sagittal Split Osteotomies: A Longitudinal and Long-Term Follow-Up Study

The aim of the study was to conduct a long-term prospective follow-up on the stability of soft tissues after bilateral sagittal split osteotomy (BSSO) with rigid internal fixation to set back the mandible. Seventeen consecutive patients (6 females, 11 males) were re-examined 12.7 years (T5) after surgery. The precedent follow-ups included: before surgery (T1), 5 days (T2) after surgery, 6.6 months (T3) after surgery, and 14.4 months after (T4) surgery. Lateral cephalograms were traced by hand, digitized, and evaluated with the Dentofacial Planner program (Dentofacial Software, Toronto, Canada). The x-axis for the system of coordinates ran through Sella (point 0) and the line NSL -7 degrees. The net effect of the soft tissue chin (soft tissue pogonion) was 79% of the setback at pogonion. At the lower lip (labrale inferior) it was 100% of the setback at lower incisor position. Point B' followed point B to 99%. Labrale inferior and menton' also showed a significant backward, as well as a downward, movement (T5 to T2). Gender correlated significantly (P = .004) with the anterior displacement of point B' and pogonion' (P = .012). The soft tissue relapse 12.7 years after BSSO setback surgery at point B' was 3% and 13% at pogonion'. Among the reasons for 3-dimensional long-term soft tissue changes of shape, the surgical technique, the normal process of human aging, the initial growth direction, and remodeling processes must be considered. Growth direction positively influenced the long-term outcome of setback surgery in female compared with male patients because further posterior movement of the mandibular soft tissue occurred.

Long-term hard and soft tissue relapse rate after genioplasty

Purpose: The purpose of this study was to assess hard and soft tissue stability 12 months after advancement genioplasty. Material And Methods: This is a retrospective study of 20 patients who underwent either advancement genioplasty alone (n = 11) or in combination with bilateral sagittal split osteotomy for mandibular advancement (n = 9). Lateral cephalometric radiographs were traced and immediate postoperative changes and 12-month postoperative changes were defined. The relapse rate for the pogonion, the soft tissue pogonion, and the soft tissue B point (Bs) were evaluated. The results were compared for combined mandibular advancement plus genioplasty versus genioplasty alone. Relapse rates were also correlated with the amount of advancement. All patients were treated with rigid internal fixation. Results: After 12 months, the pogonion, the soft tissue pogonion, and the soft tissue B point had a mean relapse rate of –0.38 mm, –1.2 mm, and –1.5 mm (negative value indicates a relapse, and a positive value indicates prolapse), respectively, which was not significant at probability values of .45, .069, and .054, respectively. Relapse was not statistically related to the amount of advancement. There was no significant difference between the relapse rate for genioplasty alone versus combined bilateral sagittal split osteotomy and genioplasty, even with different amounts of advancement. Conclusions: Advancement genioplasty is an important and reliable technique for the esthetic treatment of the lower facial skeleton. The results indicate that there is no significant relapse after genioplasty and bilateral sagittal split osteotomy or genioplasty alone after 12 months when rigid internal fixation is used. The changes were minimal and hard to detect clinically. Genioplasty, with or without mandibular advancement, is a stable surgical procedure when used in conjunction with rigid internal fixation. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:153-6)

Factors predicting long-term survival for metastatic breast cancer patients treated with high-dose chemotherapy and bone marrow support

Poor prognosis of Stage IV breast cancer patients have at best a 10% 3-year survival rate with conventional chemotherapy. Dose-intensive chemotherapy improved survival rates for some of these patients. All patients were Stage IV estrogen receptor-negative or estrogen receptor-positive hormonal refractory and received conventional chemotherapy (induction phase) to the point of achieving maximal response; if disease was stable or the patients responded, they entered high-dose chemotherapy (intensive phase). Seventy-six percent of the patients received two high-dose treatments with cyclophosphamide (4.5-6.0 g/m2), etoposide (750-1500 mg/m2), and cisplatin (120-180 mg/m2). Patients were randomized to receive or not receive autologous marrow. To identify prognostic factors for survival, univariate statistical analysis and multivariate models were applied to patient subsets. Univariate analysis identified a number of factors whose presence indicates improvement in overall survival rates. These include: (1) absence of liver relapse (P = 0.001); (2) absence of soft tissue relapse (P = 0.001); (3) a smaller number of metastatic sites at the time of detecting Stage IV disease (P = 0.026); and (4) disease-free interval greater than 1 year from initial diagnosis to Stage IV disease (P = 0.011). Multivariate models were fitted to the data, and three variables were identified as independent negative predictors for overall survival: (1) liver site (P = 0.001); (2) soft tissue site (P = 0.039); and (3) prior adjuvant chemotherapy (P = 0.028). Shorter survival after high-dose chemotherapy is predicted independently by patients pretreated with adjuvant chemotherapy, by disease distributed to the liver or the soft tissue.