Adjuvant chemotherapy for oseosarcoma – pro

Despite an optimal loco-regional treatment, 35%–50% of patients with sarcoma will develop metastasis. Systemic chemotherapy is then the standard treatment; the active drugs are doxorubicin and ifosfamide and, to a lesser extent, dacarbazine. In the adjuvant setting, NCCN recommends “a combination of two of the following agents: doxorubicin, ifosfamide, high dose methotrexate and growth factors”(p.10).

If there had been neoadjuvant chemo, as in this case, adjuvant therapy appears to be ineffective. A second course of chemotherapy for osteosarcoma after a neoadjuvant course and surgical resection does not appear to increase survival, but does increase the risk of a secondary malignancy and complications resulting from neutropenia. Still NCCN recommends chemo even after neo-adjuvant chemotherapy. On p.21 NCCN recommends continuing the same chemo, not a different chemo, adjuvantly. The Europena Guideline says: ”
Although most protocols include both pre- and postoperative chemotherapy, this has not been proven to add survival benefit over postoperative chemotherapy alone”. I consider a different chemo regimen than the preop regimen to be investigational.

BEREND Keith R et al, Adjuvant chemotherapy for Osteosarcoma may not increase survival after neoadjuvant chemotherapy and surgical resection Journal of surgical oncology 2001, vol. 78, no3, pp. 162-170 (31 ref.)

G. Saeter ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of osteosarcoma Ann Oncol 14: 1165-1166. 2005, bone cancer 2012

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