Kveller C, Safwat A, Lindegaard JC, Bendtsen MM, Baad-Hansen T. Long-term functional follow-up of pediatric extremity sarcoma patients treated with brachytherapy. World J Orthop 2026; 17(8): 122034 [DOI: 10.5312/wjo.122034]
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Christian Kveller, MD, Consultant, Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Midtjylland, Denmark. chrkve@rm.dk
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Orthopedics
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Kveller C, Safwat A, Lindegaard JC, Bendtsen MM, Baad-Hansen T. Long-term functional follow-up of pediatric extremity sarcoma patients treated with brachytherapy. World J Orthop 2026; 17(8): 122034 [DOI: 10.5312/wjo.122034]
World J Orthop. Aug 18, 2026; 17(8): 122034 Published online Aug 18, 2026. doi: 10.5312/wjo.122034
Long-term functional follow-up of pediatric extremity sarcoma patients treated with brachytherapy
Christian Kveller, Akmal Safwat, Jacob C Lindegaard, Michael M Bendtsen, Thomas Baad-Hansen
Christian Kveller, Michael M Bendtsen, Thomas Baad-Hansen, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus 8200, Midtjylland, Denmark
Akmal Safwat, Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus 8200, Midtjylland, Denmark
Jacob C Lindegaard, Department of Oncology, Aarhus University Hospital, Aarhus 8200, Midtjylland, Denmark
Author contributions: Kveller C, Bendtsen MM, and Baad-Hansen T conceived and designed the study; Kveller C performed data collection and wrote the first draft; Kveller C, Safwat A, Lindegaard JC, and Bendtsen M contributed to writing, reviewing, and editing of the manuscript; Baad-Hansen T contributed to supervision. All authors reviewed and approved the final manuscript.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Institutional review board statement: The project was approved by the institutional review board under the filing: No. 284/1-10-72-274-21.
Informed consent statement: The authors certify that they have obtained all appropriate patient and parent consent forms.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement:sharing statement: Anonymized data is available upon reasonable request to the corresponding author.
Corresponding author: Christian Kveller, MD, Consultant, Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Midtjylland, Denmark. chrkve@rm.dk
Received: April 14, 2026 Revised: May 18, 2026 Accepted: June 24, 2026 Published online: August 18, 2026 Processing time: 126 Days and 20.8 Hours
Abstract
BACKGROUND
Pediatric sarcomas of the extremities are most often treated with a combination of surgery, chemotherapy, and radiotherapy. Due to the limited anatomical dimensions in children, limb-sparing surgery with adequate surgical margins may be challenging. In addition, external beam radiotherapy near growth zones can result in abnormal or compromised development. However, the steep dose gradient of brachytherapy may deliver a sufficient radiation dose to the tumor or tumor bed while sparing surrounding tissues to a greater extent than external beam radiation techniques.
AIM
To assess functional outcomes and the long-term effects of brachytherapy on extremity function in pediatric patients treated at our institution.
METHODS
A retrospective cohort of patients was identified through internal hospital records. Patients were recruited during routine follow-up appointments, during which they were interviewed and completed patient-reported outcome measures.
RESULTS
Three patients treated with brachytherapy were included in the analysis. No recurrences were observed during follow-up, which ranged from 5-9 years. Two patients were treated at or near a physis, and both developed limb-length discrepancy, which was symptomatic in one patient with lower extremity involvement. Two of the three patients experienced progressive functional impairment that worsened with growth because of unyielding cicatricial tissue, with more pronounced impairment in the patient with lower extremity involvement. Extensive soft-tissue resection was performed in two patients, both of whom reported decreased endurance in the affected limb. Despite surgery and radiation adjacent to major peripheral nerves, no patients reported neural deficits.
CONCLUSION
Brachytherapy is a viable alternative to external beam radiotherapy for pediatric extremity sarcomas and may provide favorable functional outcomes; in our cohort, no patients experienced local recurrence. However, ongoing skeletal growth presents challenges in achieving optimal long-term functional outcomes. Close collaboration with oncology late-effects clinics and pediatric orthopedic surgeons may be beneficial, as postoperative sequelae in patients treated with brachytherapy may resemble growth-related musculoskeletal abnormalities.
Core Tip: Brachytherapy is a viable alternative to external beam radiotherapy for pediatric extremity sarcomas and may provide acceptable functional outcomes. However, it does not eliminate growth-related complications, and ongoing skeletal growth presents challenges in achieving optimal long-term functional outcomes. Close cooperation with oncology late-effects clinics and continued evaluation by pediatric orthopedic surgeons may help optimize long-term care.
