From the Guidelines
Neoadjuvant chemotherapy prior to surgery does not significantly improve mortality rates for osteosarcoma patients, according to the most recent evidence. The use of neoadjuvant chemotherapy in osteosarcoma treatment is a complex issue, and the latest guidelines suggest that it may not be beneficial for all patients 1.
Key Points to Consider
- A study of 291 patients with periosteal osteosarcoma found no statistically significant improvement in mortality rates among those who received surgery and (neo-) adjuvant chemotherapy and those who received surgery alone 1.
- Neoadjuvant chemotherapy prior to wide excision is preferred for those with high-grade osteosarcoma, but the evidence for its benefit in terms of mortality rates is not strong 1.
- The treatment approach for osteosarcoma typically involves giving chemotherapy before surgical resection, followed by additional chemotherapy after surgery, but the benefits of this approach in terms of mortality rates are not clearly established 1.
Treatment Approach
The standard treatment approach for osteosarcoma involves a combination of chemotherapy and surgery, but the use of neoadjuvant chemotherapy should be individualized based on the patient's specific condition and the tumor's characteristics 1. Patients whose disease has a good histologic response to preoperative chemotherapy may continue to receive several more cycles of the same chemotherapy, while those with a poor response may be considered for chemotherapy with a different regimen 1.
Important Considerations
- The percentage of tumor necrosis found after neoadjuvant chemotherapy is an important prognostic indicator, but the evidence for its benefit in terms of mortality rates is not strong 1.
- The use of neoadjuvant chemotherapy in osteosarcoma treatment should be carefully considered, taking into account the potential benefits and risks, as well as the individual patient's condition and preferences 1.
From the Research
Neoadjuvant Chemotherapy for Osteosarcoma
- The use of neoadjuvant chemotherapy prior to surgery for osteosarcoma has been a topic of research, with studies examining its effectiveness in improving patient outcomes 2, 3, 4, 5, 6.
- A study published in 2020 found that the optimal treatment scheme for osteosarcoma patients with metastases at presentation has not yet been defined, but chemotherapy, surgery, and radiotherapy are considered the best treatment options 2.
- Another study from 2003 reported that neoadjuvant chemotherapy with cisplatin, doxorubicin, and a high dose of methotrexate and ifosfamide resulted in a 2-year event-free survival (EFS) and overall survival (OS) of 21% and 55%, respectively, in patients with osteosarcoma of the extremity and metastatic disease at presentation 3.
- A 2024 review of neoadjuvant chemotherapy for adults with osteogenic sarcoma noted that the introduction of the MAP regimen (methotrexate, doxorubicin, and cisplatin) in the 1970s and 1980s significantly improved patient outcomes, but development of better therapeutic approaches has stalled since then 4.
- Meta-analyses published in 2019 and 2024 found that the MAP regimen remains the preferred option for osteosarcoma chemotherapy, with no significant differences in disease-free survival and overall survival compared to other regimens, but with less frequent adverse events 5, 6.
Adverse Events and Outcomes
- The MAP regimen has been associated with less frequent adverse events, such as thrombocytopenia, febrile neutropenia, anemia, and hypophosphatemia, compared to other regimens 5, 6.
- A meta-analysis published in 2024 found that the control group (non-MAP regimens) was associated with statistically meaningful adverse events compared to the MAP group, particularly in thrombocytopenia and fever 6.
- The 5-year overall survival analysis revealed a significant association in the control group, but the MAP regimen remains preferable in treating osteosarcoma patients due to its less frequent adverse events 6.
Treatment Considerations
- A multidisciplinary approach by surgeons, medical oncologists, and radiotherapists is important for osteosarcoma patients, especially those with metastatic disease at presentation 2.
- The use of neoadjuvant chemotherapy prior to surgery may be considered for patients with osteosarcoma, but the optimal treatment scheme has not yet been defined 2, 3, 4, 5, 6.