Doxorubicin Dose Deintensification in Pediatric Osteosarcoma, Is Less Better?

Introduction We implemented new clinical practice guidelines (CPG) for patients with osteosarcoma starting in January 2009. These were based on standard European and American Osteosarcoma Study regimen, which includes six cycles of doxorubicin a cumulative dose 450 mg/m2. Aiming to reduce cardiac toxicity at our center, we opted the 375 Methods This is retrospective cohort aged <18 years, treated center between 2009 2018. Patients unified CPG prospectively followed. Disease treatment characteristics depicted, survival rates calculated. When needed, comparison different groups conducted using log-rank test. Results After median follow-up 43.3 months (range, 2–153 months), 79 diagnosed dose-reduced doxorubicin. Median age diagnosis was 12.8 years. At diagnosis, 58 (73%) had localized disease. The 5-year event-free (EFS) whole group 50 ± 5.9%, overall (OS) 64 5.7%. For extremity nonmetastatic tumors (N = 56), EFS OS 60 6.9% 70 6.8%, respectively, this patients, response chemotherapy associated better (p 0.0048) 0.013). Only two suffered transient dysfunction, resolved after treatment. Conclusion Our findings suggest that deintensification may provide adequate control pediatric osteosarcoma. In absence large randomized trials addressing issue, developing countries less resources treat heart failure consider lower dose.