Outcomes Following Limb Sparing Surgery for Soft Tissue Sarcoma

Body Image, Health-related Quality of Life, and Function After Soft Tissue Sarcoma Resection

The goal of this study is to assess body image, health-related quality of life (QoL), and functioning (gait function, joint function, and walking ability) in patients after resection of localized soft tissue sarcoma (STS) of the extremities. A secondary objective is to assess the influence of different variables (e.g., radiotherapy, ethnicity, etc.) on body image, health-related QoL, and functioning.

Patients who underwent a surgical resection at the Amsterdam UMC between 2010 and 2021 will be approached to participate in the study. Participants will complete four questionnaires and undergo a physical examination. Additionally, they will have a 3D gait analysis, a 6-minute walk test with gas analysis, and a muscle strength assessment. Furthermore, muscle volume change will be evaluated on pre- versus postoperative MRI scans.

Primary objectives :

• To assess body image, health-related QoL, self-reported activity limitations, and pain after STS resections as defined in the The International Classification of Functioning, Disability and Health (ICF) domains.

• To assess the functioning of the patients after STS resections as defined by the ICF domains of body function, body structure, and activities and participation:

• Body function:

  1. Evaluate impairments in gait biomechanics.
  2. Evaluate impairments in joint function as determined by range of motion and muscle strength.

• Body structure:

  a. Evaluate muscle volume change on pre- and postoperative MRI scans and correlate these findings with body image, health-related quality of life, activity limitations, and functional impairments.

• Activities and participation:

  1. Objectify activity limitations by walking speed, and energy cost.
  2. Objectify balance and mobility as measured by Timed Up and Go (TUG) test and Timed Up and Down Stairs (TUDS) test.

Secondary objectives:

• To identify factors associated with body image, health-related QoL and functioning in extremity STS survivors.
• To compare body image, health-related QoL and functioning between patients who were treated with and without radiotherapy.

Srudy design:

This is a cross-sectional follow-up study. All records of consecutive non-metastatic extremity STS patients who underwent surgical resection between 2010 and 2021 at the Amsterdam UMC will be evaluated. Both deceased patients and survivors are included to obtain a realistic picture of the entire population. Survivors (approximately N = 125-150) will be approached to take part in this study by phone, followed by a letter explaining the study, including an informed consent form.

At baseline, patient demographics, tumor characteristics, diagnostics, and treatments will be collected. The participants can either fill out the self-reported questionnaires at home through the internet (using EPIC/Castor) or on a tablet at the outpatient clinic with the help of the investigator.

Participants will be invited to visit the outpatient clinic for a physical examination, which will include assessments of joint range of motion, limb circumference, balance, and mobility. Balance and mobility will be evaluated using the Timed Up and Go (TUG) test and the Timed Up and Down Stairs (TUDS) test. Muscle strength will be assessed using a hand-held dynamometer and the Medical Research Council (MRC) scale. Participants can complete the computer-based questionnaires at the outpatient clinic if not already completed at home. This part of the study will take place at the Department of Orthopedic Surgery and Sports Medicine.

Additionally, participants will undergo a 3D gait analysis to assess gait biomechanics, a muscle strength assessment using a Biodex dynamometer, and a 6-minute walk test to evaluate walking speed and energy cost. These assessments will be conducted at the Department of Rehabilitation.

Depending on the test, results will be compared as follows:

• Against general population means
• Between patients who have undergone upper and lower extremity STS resection
• Between the affected limb and the contralateral healthy limb

Additionally, the results from the objective functional tests and the MRI-scans (with tumor and pre- plus postoperative muscle specific features) will be correlated with body image and health-related QoL questionnaires. To identify factors associated with body image, health-related QoL, and functioning, we will assess whether the collected factors (baseline patients and tumor characteristics, treatments, and complications) are associated with better or worse outcomes of the questionnaires and the functional tests.

Inclusion Criteria:

• Treated with surgical resection for primary non-metastatic extremity STS at the Amsterdam UMC between 2010-2021.
• Being able to visit the Amsterdam UMC, location AMC once or twice.
• Pregnant patients must agree to be scheduled 5 months after their pregnancy ends.

Exclusion Criteria:

• Patients who cannot maintain 6 minutes of walking will be excluded from the 6-minute walk test.