Role of Neo-Adjuvant Chemotherapy in the Treatment of Osteosarcoma

Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age; however, primary high grade osteosarcoma usually occurs in the second decade of life. Historically patients with osteosarcoma were treated with immediate wide or radical amputation. Despite the treatment, 80% patients with apparently isolated disease died of distant metastases. In recent years the number of patients with osteosarcoma of the limb treated by amputation + chemotherapy has increased. In our study, we divided the patients into two groups. One group (A) was treated with amputation + adjuvant chemotherapy. The other group (B) was treated with neo-adjuvant chemotherapy + amputation followed by adjuvant-chemotherapy. In our study, the margin negativity in post surgical specimen was significantly higher (P-value 0.0007) for the group treated with neo-adjuvant chemotherapy. Local recurrence in the group treated without neoadjuvant chemotherapy was significantly more (P-value 0.0005). The systemic recurrence at the end of 6 months was higher the group treated without neoadjuvant chemotherapy (P-value 0.0169). However systemic recurrence between 6 months -1 year and 1 year 2 years were not significant (P-values 0.1501 and 0.4902). From the above figures it may be concluded that treatment with neo-adjuvant chemotherapy + amputation + adjuvant chemotherapy had definite advantages over upfront amputation + adjuvant chemotherapy.