Soft tissue and bone sarcomas of the lower extremity pose significant challenges for affected individuals, often associated with considerable burden. Chemotherapy, load restrictions, and surgery frequently result in long-term physical limitations, causing structural and functional deterioration. These challenges are particularly pronounced in childhood and adolescence, as they affect physiological development, resilience, and autonomy. Yet, it remains unclear whether these deficits can be fully compensated after treatment or if they result in long-term limitations, as this has not been sufficiently studied. This bicentric study includes children and adolescents undergoing follow-up care for soft tissue or bone sarcoma of the lower extremity within 1 to 5 years since end of therapy. The cohort did not receive any specific prehabilitative training during neoadjuvant therapy. Participants will be divided into two subgroups based on the study site: (1) participants who participated in a non-specific exercise program during acute therapy and (2) participants who did not receive any exercise promotion during acute therapy. Target sample size is n=16. The study has been consented by the local ethics committee. Several structural and functional parameters are measured to document the natural status of muscular structures and functional abilities after the treatment of a solid tumor in the lower extremities, with a focus on identifying specific deficits and the associated long-term limitations in daily life. The measurements include psoas muscle area, body composition, strength, mobility, balance ability, gait analysis, two questionnaires on physical activity and quality of life, and quantitative measures of the clinical course during acute treatment (days of hospitalization, infection rates, etc.). For children and adolescents, daily functionality and the experience of autonomy are crucial for physiological development and contribute significantly to quality of life. Therefore, these factors should be investigated and supported in this cohort, a group that is currently underrepresented in scientific research.
Study Type
OBSERVATIONAL
Enrollment
18
Dr. von Haunersches Kinderspital, University of Munich
Munich, Bavaria, Germany
Technical University of Munich, Germany; TUM School of Medicine and Health, Department of Pediatrics. German Center for Child and Adolescent Health (DZKJ), partner site Munich
Munich, Bavaria, Germany
Total psoas muscle area
Total psoas muscle area at lumbal level (L4) analyzed via MRI or PET CT
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Fat-free mass
The weight of all body components excluding fat, measured in kilograms, using bioimpedance analysis. Outcome measures 2.-6. will be combined to report body composition.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Fat mass
Total body fat weight, measured in kilograms, assessed via bioimpedance analysis. Outcome measures 2.-6. will be combined to report body composition.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Total body water
The proportion of total body water in kg, expressed as percentage, measured through bioimpedance analysis. Outcome measures 2.-6. will be combined to report body composition.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Body cell mass
The mass of metabolically active cells in the body, measured in kilograms, via bioimpedance analysis. Outcome measures 2.-6. will be combined to report body composition.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Phase angle
An indicator of cellular health and membrane integrity, measured in degrees using bioimpedance analysis. Outcome measures 2.-6. will be combined to report body composition.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Muscle strength
Overall muscle strength measured by hand-grip dynamometry.
Time frame: At diagnostic procedure, 1-5 years following the end of therapy
Range of motion of the adjacent joints
Range of motion of the adjacent joints measured with an analog goniometer.
Time frame: At diagnostic procedure, 1-5 years following the end of therapy
Gait analysis
Gait analysis measured with a force plate to analyze how pressure is distributed during stance phases of walking (vertical ground reaction force during loading response, mid stance, terminal stance, toe off).
Time frame: At diagnostic procedure, 1-5 years following the end of therapy
Path length
The total distance traveled by the center of pressure during balance assessment, measured in centimeters using a force plate. Outcome measures 10.-13. will be combined to report balance ability.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Mean velocity
The average speed of center of pressure shifts during balance assessment, measured in meters per second with a force plate. Outcome measures 10.-13. will be combined to report balance ability.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Sway angle
The angular deviation of the center of pressure from a neutral position during balance tasks, measured in degrees using a force plate. Outcome measures 10.-13. will be combined to report balance ability.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Equlibrium score
Calculated from the anterior-posterior and medial-lateral projection of the 90% Standard Ellipse and estimated height of center of gravity during balance tasks in percentage using a force plate. Outcome measures 10.-13. will be combined to report balance ability.
Time frame: At diagnostic procedure 1-5 years following the end of therapy
Level of physical activity
Level of physical activity following therapy measured with the standardized ActiOn questionnaire
Time frame: At diagnostic procedure, 1-5 years following the end of therapy
Quality of life
Quality of life during and following therapy measured with the standardized and validated KINDL questionnaire
Time frame: At diagnostic procedure, 1-5 years following the end of therapy
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