Chemotherapy for osteosarcoma: Literature review and experience of Taipei veterans general hospital

Objective: This article reviews the current standard of care for osteosarcoma and the experience of Taipei Veterans General Hospital. Data Sources and Study Selection: We searched PubMed using the keyword “osteosarcoma” and article type “Clinical Trial.” Prospective, randomized, Phase II/III clinical trials which resulted in practice change were enrolled. In addition, retrospective studies from Taipei Veterans General Hospital were also included. Results: For localized conventional osteosarcoma, combined perioperative chemotherapy with surgical resection dramatically improved long-term outcomes. Combination chemotherapy with methotrexate, Adriamycin, and cisplatin (MAP) is currently widely accepted to be the optimal regimen. The efficacy of chemotherapy has increased the likelihood of a limb-salvage approach, which has become the mainstay of surgery. In Taipei Veterans General Hospital, MAP plus ifosfamide was used and could achieve a 5-year overall survival (OS) rate of 77% and progression-free survival (PFS) rate of 70% for all patients. For nonmetastatic osteosarcoma, the 5-year OS and PFS rates reached 90% and 83%, respectively. For recurrent/metastatic disease, there is currently no satisfactory systemic therapy. Removal of all tumors should be attempted if clinically feasible, because one-third of patients may survive for 5 years or more if the tumors are completely resected. Conclusion: Perioperative chemotherapy is associated with excellent OS, PFS, and limb salvage rates and is the current standard of care for osteosarcoma.