Osteosarcoma journey over two decades in India: Small steps, big changes.

Area of Science:

• Oncology
• Chemotherapy
• Osteosarcoma Management

Background:

• Osteosarcoma treatment is challenging, particularly in low-resource settings.
• There's a critical need for effective and sustainable chemotherapy regimens.

Purpose of the Study:

• To compare outcomes of nonmetastatic osteosarcoma patients treated with three sequential chemotherapy protocols.
• To evaluate the impact of evolving chemotherapy regimens and supportive care on patient survival and toxicity.

Main Methods:

• Retrospective and prospective chart review of 510 nonmetastatic osteosarcoma patients over two decades.
• Comparison of three protocols: OGS-99, OGS-99 enhanced (with etoposide and enhanced support), and OGS-12 (dose-dense, with growth factors and nutritional support).
• Assessment of event-free survival (EFS), overall survival (OS), and treatment toxicity.

Main Results:

• Five-year EFS rates improved from 38% (OGS-99) to 50% (OGS-99 enhanced) and 62% (OGS-12).
• Five-year OS rates were 60% for OGS-99 enhanced and 77% for OGS-12.
• Acceptable toxicity rates were observed, with 1% treatment-related deaths.

Conclusions:

• Sequential, dose-dense chemotherapy combined with enhanced supportive care significantly improves outcomes for nonmetastatic osteosarcoma.
• The "small steps-big changes" model demonstrates a successful strategy for optimizing osteosarcoma treatment.