Chemotherapy in Nonmetastatic Osteosarcoma: Recent Advances and Implications for Developing Countries

Area of Science:

• Oncology
• Pediatric Oncology
• Bone Cancers

Background:

• Osteosarcoma (OS) is a primary bone tumor primarily affecting children and adolescents.
• Standard treatment involves neoadjuvant/adjuvant chemotherapy and surgery.
• Current regimens often use high-dose methotrexate, cisplatin, and doxorubicin (MAP).

Purpose of the Study:

• To review chemotherapy challenges in nonmetastatic OS, particularly in Indian settings.
• To evaluate the efficacy of high-dose methotrexate versus non-high-dose methotrexate regimens.
• To explore alternative chemotherapy strategies for OS.

Main Methods:

• Literature review comparing methotrexate-containing and non-methotrexate-containing regimens.
• Focus on non-methotrexate triple-drug therapies.
• Analysis of challenges in resource-limited settings.

Main Results:

• Limited data support the superiority of high-dose methotrexate regimens over non-high-dose methotrexate regimens.
• High-dose methotrexate is the standard in developed countries, but its advantage is not definitively proven.

Conclusions:

• Developing countries may opt for non-high-dose methotrexate regimens due to infrastructure and logistical limitations.
• Focus should be on early detection, multidisciplinary care, and improved surgical/pathologic evaluations in resource-limited settings.