Evidence brief
Neoadjuvant Chemotherapy in Osteosarcoma
Neoadjuvant chemotherapy allows tumor response assessment
Good responders (>90% necrosis) have better prognosis
Huvos grading: I (<50%), II (50-90%), III (>90%), IV (100%)
Response guides adjuvant therapy
MAP (methotrexate, adriamycin, cisplatin) backbone
Neoadjuvant chemotherapy followed by surgery then adjuvant chemotherapy is standard for osteosarcoma. Histological response to chemotherapy is the most important prognostic factor.
Know Huvos grades and significance. Good response (III/IV) = better prognosis. Poor response = may change adjuvant regimen. Standard agents: high-dose methotrexate, doxorubicin, cisplatin. Discuss multidisciplinary team approach.
Rosen G et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer. 1982;49(6):1221-1230.
Level III
Retrospective comparative study or case-control study