Clinical Outcome Following Prolonged Neoadjuvant Chemotherapy and Delayed Surgery in Osteosarcoma Patients

Abstract

Introduction The management of osteosarcoma has been revolutionized by neoadjuvant chemotherapy (NCT) preceding surgery, an approach aimed at reducing tumor size and eradicating micrometastases. This literature review synthesizes key findings on the clinical outcomes following prolonged NCT and delayed surgery in osteosarcoma patients.

Methods This comprehensive review analyzes nine pivotal articles published between 2008 and 2023. It examines the evolution of treatment, the prognostic significance of histological response to NCT, surgical outcomes, and the roles of biomarkers and chemotherapy dose intensity.

Results The literature consistently identifies histological response as the most critical prognostic factor. A tumor necrosis rate greater than 90% after NCT is strongly associated with improved long-term survival. This response guides surgical decisions, including the feasibility of limb salvage. Achieving complete tumor resection with clear surgical margins is another principal determinant of positive outcomes. The presence of metastases at diagnosis remains a major adverse prognostic factor , while maintaining chemotherapy dose intensity is crucial for survival.

Discussion The findings reveal a synergistic relationship where NCT is both therapeutic and prognostic, guiding subsequent surgery. The tumor's response to initial chemotherapy is paramount indicating that an integrated, multi-modal strategy is superior to a singular treatment approach and is essential for successful management.

Conclusion Prolonged NCT followed by definitive surgery is the standard of care for osteosarcoma. The degree of histological tumor response is the most powerful predictor of clinical outcome. Future efforts should focus on developing biomarkers and targeted therapies to improve response rates and personalize treatment, especially for poor responders.