Treatment of High-Grade Resectable Osteosarcoma in Patients Aged 40 Years or Younger

This protocol addresses curative-intent management of high-grade osteosarcoma when the tumour is resectable and the patient is 40 years of age or younger — the age group in which this histological subtype most commonly arises and for which the strongest evidence exists.

Clinical Scenario

Conventional osteosarcoma is always high-grade. This protocol applies when resection with curative intent is feasible in a patient aged 40 or younger — a population for whom specific front-line chemotherapy protocols have been validated in children and young adults.

Treatment Approach (Partial Overview)

Curative treatment combines multi-agent chemotherapy with surgery. The approach includes a preoperative chemotherapy phase followed by surgical resection, with limb salvage pursued where achievable. The complete regimen, sequencing, eligibility criteria, and surgical margin requirements are detailed in the structured protocol →

Key Treatment Goal

A central measure of response is the degree of tumour necrosis in the resected specimen. Achieving 90% or greater tumour necrosis on the surgical specimen indicates a good histological response to preoperative chemotherapy.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2021.08.1995

Conventional osteosarcoma is always high-grade.
Curative treatment of high-grade osteosarcoma consists of ChT and surgery [II, A].
The doxorubicin/cisplatin/HD-MTX (MAP) regimen is most frequently used as front-line ChT in children and young adult patients; however, HD-MTX can be challenging to administer in adults.
Most current protocols for localised disease include a period of preoperative ChT, to facilitate local surgical treatment and to allow the assessment of histological response, although there is no evidence to support a change in ChT based on this alone.
Most patients should be considered candidates for limb salvage.
In osteosarcoma, a cut-off value of 10% viable tumour cells or 90% response is used to indicate a good response.

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