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

This protocol addresses a defined clinical scenario: high-grade osteosarcoma with a resectable primary tumour in patients aged 40 years or younger — a population that includes children, adolescents, and young adults.

Clinical Scenario

The protocol applies when three conditions are met: high-grade osteosarcoma, resectable tumour, and age ≤ 40 years. Conventional osteosarcoma is inherently high-grade. In the ≤40 age group, treatment regimen selection reflects both disease biology and age-related considerations that distinguish this population from older patients.

Treatment Approach (Partial Overview)

Management involves a chemotherapy strategy that may incorporate alkylating agents, potentially combined with additional cytotoxic drugs. An alternative chemotherapy combination is also recognised. Radiotherapy may have a role in specific clinical circumstances. Full regimen options, drug selection, and sequencing are available in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

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.
Treatment choice may take into account prior DFS, ChT regimens previously used and often includes ifosfamide or cyclophosphamide, possibly in association with etoposide and/or carboplatin [III, B], and other active drugs including gemcitabine and docetaxel [IV, C].
RT may have a role in palliation.

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