This protocol addresses patients aged 40 years or younger with high-grade, resectable osteosarcoma. Conventional osteosarcoma is always high-grade. The MAP regimen is the most frequently used front-line chemotherapy in children and young adult patients, though high-dose methotrexate can be challenging to administer in adults.
These patients previously received neoadjuvant chemotherapy with doxorubicin, cisplatin, and high-dose methotrexate (MAP regimen), followed by wide surgical excision with limb salvage where feasible, and adjuvant MAP chemotherapy — with metastasectomy for resectable pulmonary metastases. This next-line protocol applies when that approach did not achieve 90% or greater tumour necrosis on the surgical specimen, indicating a poor histological response to preoperative chemotherapy.
Management after insufficient histological response is centred on surgical intervention directed at metastatic disease. Alternative local treatment approaches may also be considered for selected patients who are not surgical candidates. The full structured regimen — including complete criteria, all options, and the clinical algorithm — is available via the link below.
DOI: 10.1016/j.annonc.2021.08.1995
Conventional osteosarcoma is always high-grade.
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.
The treatment of recurrent osteosarcoma is primarily surgical in patients with isolated lung metastases or LR.
Complete removal of all resectable metastases must be attempted, as more than one-third of patients with a complete second surgical remission survive for >5 years.
Even patients with subsequent recurrences may be cured as long as recurrences are resectable, and repeated thoracotomies are often warranted.
For lung metastases, stereotactic RT, radiofrequency ablation (RFA) or cryotherapy might be used as alternative options in patients unfit for surgery.
View source ↗