Role of Neo-Adjuvant Chemotherapy in the Treatment of Osteosarcoma

Abstract

Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age; however, primary high grade osteosarcoma usually occurs in the second decade of life. Historically patients with osteosarcoma were treated with immediate wide or radical amputation. Despite the treatment, 80% patients with apparently isolated disease died of distant metastases. In recent years the number of patients with osteosarcoma of the limb treated by amputation + chemotherapy has increased. In our study, we divided the patients into two groups. One group (A) was treated with amputation + adjuvant chemotherapy. The other group (B) was treated with neo-adjuvant chemotherapy + amputation followed by adjuvant-chemotherapy. In our study, the margin negativity in post surgical specimen was significantly higher (P-value 0.0007) for the group treated with neo-adjuvant chemotherapy. Local recurrence in the group treated without neoadjuvant chemotherapy was significantly more (P-value 0.0005). The systemic recurrence at the end of 6 months was higher the group treated without neoadjuvant chemotherapy (P-value 0.0169). However systemic recurrence between 6 months -1 year and 1 year -2 years were not significant (P-values 0.1501 and 0.4902). From the above figures it may be concluded that treatment with neo-adjuvant chemotherapy + amputation + adjuvant chemotherapy had definite advantages over upfront amputation + adjuvant chemotherapy.

Examining the Outcome of Osteosarcoma: 10-Year Experience in a Referral Center South of Iran

“…Men exhibit slightly higher incidence, except for parosteal osteosarcoma which affect women more commonly. No significant difference is observed between races, and genetic factors rarely are involved in the prevalence of this disease (7). The appearance of osteosarcoma radiographs is varied, but plain radiographs have been the most reliable tool for accurate diagnosis.…”