Osteosarcoma — SCE Medical Oncology MCQ

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ModerateSarcomaOsteosarcomaSCE Medical Oncology

A 60-year-old man with high-grade osteosarcoma of the distal femur (no metastases) is being planned for curative treatment. What is the standard multimodality approach?

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Correct answer: D — Neoadjuvant chemotherapy (MAP: methotrexate, doxorubicin, cisplatin) → surgery → adjuvant chemotherapy

High-grade osteosarcoma in adults is treated with the MAP regimen (high-dose methotrexate, doxorubicin/Adriamycin, cisplatin/Platinol): 2-3 cycles neoadjuvant → limb-sparing surgery (or amputation if necessary) → adjuvant chemotherapy to complete approximately 6 months total. Histological response to neoadjuvant chemotherapy (≥90% necrosis = good responder) is the strongest prognostic factor. Ifosfamide can be added for poor responders (EURAMOS-1). Osteosarcoma is poorly radiosensitive.

Reference: ESMO 2024 Osteosarcoma Guidelines; EURAMOS-1; NICE NG Bone sarcoma pathway