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However, the extent and progression of muscle loss during treatment for childhood cancers remain unclear. A better understanding could help identify children at increased risk and inform the timing of targeted intervention. This systematic review and meta-analysis aimed to synthesize the evidence on skeletal muscle changes during treatment for childhood cancers and identify factors that influence these outcomes. A systematic search was conducted in CINAHL, Embase, PubMed, SPORTDiscus, and Web of Science. Studies were eligible if they included children and adolescents (&lt;\u200919\u00a0years) undergoing cancer treatment and reported muscle quantity at a minimum of two time points. The methodological quality of the included studies was evaluated using the Newcastle\u2013Ottawa Scale. Twenty studies (<jats:italic>n<\/jats:italic>\u2009=\u2009646; age range: 2.5\u201314.7\u00a0years) were included. A significant decline in muscle quantity was observed during the early phase of treatment (standardized mean difference (SMD): SMD\u2009=\u2009\u2009\u2212\u20090.36; 95% CI:\u2009\u2212\u20090.59 to\u2009\u2212\u20090.13; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). At later follow-up time points, the overall change was not statistically significant (SMD\u2009=\u2009\u2009\u2212\u20090.08; 95% CI:\u2009\u2212\u20090.27 to 0.10; <jats:italic>p<\/jats:italic>\u2009=\u20090.36). However, estimates of muscle quantity varied significantly by assessment modality (<jats:italic>p<\/jats:italic>\u2009=\u20090.048).<\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusion<\/jats:italic>: Children with cancer experience significant skeletal muscle loss during the intensive phase of treatment. While decrements observed at later time points appear modest, reported outcomes vary considerably depending on the assessment method. Standardized, reliable body composition measures are needed to detect meaningful changes and guide clinical care.\n<jats:table-wrap>\n              <jats:table>\n                <jats:tbody>\n                  <jats:tr>\n                    <jats:td align=\"left\">What is Known:\u2022 Skeletal muscle loss during adult cancer treatment is linked to poor outcomes, yet pediatric data are limited and inconsistent.<\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">What is New:\u2022 This is the first systematic review and meta-analysis showing significant early-phase skeletal muscle loss in children undergoing cancer treatment, accompanied by concurrent increases in fat mass.\u2022 Considerable variability in skeletal muscle estimates across different body composition assessment methods underscores the need for reliable and sensitive measurement techniques to monitor changes accurately and guide clinical care.<\/jats:td>\n                  <\/jats:tr>\n                <\/jats:tbody>\n              <\/jats:table>\n            <\/jats:table-wrap>\n          <\/jats:p>","DOI":"10.1007\/s00431-025-06349-5","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T04:26:28Z","timestamp":1753935988000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Longitudinal changes in skeletal muscle in children undergoing cancer treatment: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"184","author":[{"given":"Anna Maria","family":"Markarian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis R.","family":"Taaffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Galv\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn J.","family":"Peddle-McIntyre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodie Cochrane","family":"Wilkie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bettariga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert U.","family":"Newton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"6349_CR1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3389\/fphar.2013.00049","volume":"4","author":"C Scheede-Bergdahl","year":"2013","unstructured":"Scheede-Bergdahl C, Jagoe RT (2013) After the chemotherapy: potential mechanisms for chemotherapy-induced delayed skeletal muscle dysfunction in survivors of acute lymphoblastic leukaemia in childhood. 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