Methotrexate Free Chemotherapy and Limb Salvage Surgery for Paediatric Osteosarcoma in India

Abstract

Background:Osteosarcoma (OS) is the most common primary malignant tumor of bone. The survival of OS patients has steadily improved from <20% in the early 20th century to around 70% with current treatment. There are very few studies in pediatric OS from India analyzing various aspects of the disease. This study focuses on the clinical profile, treatment options, and their complications and survival outcomes in pediatric osteosarcoma (OS) patients.Materials and Methods:This was a retrospective observational study which included pediatric patients <14 years of age, with newly diagnosed OS confirmed by histological diagnosis. Medical records of all patients were reviewed for clinical profile, treatment data, surgical management, and treatment complications. Patients alive at the end of treatment were followed up and overall (OAS) and disease-free survival (DFS) were analyzed.Results:Sixty-two patients were diagnosed with OS during the study of whom 55 opted for treatment. Cisplatin, adriamycin, and ifosfamide (PAI) was offered as chemotherapy and was completed as planned in the majority of patients. Limb salvage surgery was performed in most patients (87%, n = 40). The local recurrence occurred in 7 patients. The 3 years overall survival for the cohort was 54.6% ± 7.8% and DFS was 43.4% ± 7.9%, with females and those with the localized disease having a significantly better DFS.Conclusions:High dose methotrexate free chemotherapy can give good OAS in localized disease and LSS is feasible in most of the pediatric OS patients. However the modest DFS even for localized disease with PAI chemotherapy and extremely poor outcomes in the metastatic OS, demand further research and innovations in systemic therapy to improve outcomes.

Predictors of Survival in Children with Osteogenic Sarcoma Undergoing Limb Salvage Surgery: Experience from a Tertiary Cancer Center in Rural India

“…They analyzed 40 children <14 years, who underwent LSS and used the same chemotherapy regimen as in our study. [9] An interesting observation in our study was that even though our patients received nonmethotrexate containing chemotherapy, the OS and EFS are comparable to those who received methotrexate containing regimens. Methotrexate-based regimens are the standard of care in Europe and North America.…”

Resource‐appropriate selection of osteosarcoma treatment protocols in low‐ and middle‐income countries

“…Centers reported 5‐year relapse/progression‐free (PFS) survival rates in patients with osteosarcoma ranging from 40% to 68% with various combinations of the other active drugs (Figure 3A,B; Table 3). 7,8,42–61 The initial proof of non‐HDMTX protocols came from the European Osteosarcoma Intergroup (EOI) trials. While the first EOI trial compared two‐drug protocol Adriamycin‐ cisplatin (AP) to AP with HDMTX, the second trial compared AP to a T10‐like multidrug protocol 48,62 .…”

“…There are only occasional reports on HDMTX in osteosarcoma from India and other LMIC; major oncology centers in India use non‐HDMTX‐based protocols 6,7,52,61,68 . There are challenges associated with mandatory inpatient treatment in high turnover tertiary care cancer centers, while there are concerns related to possible suboptimal dosing, overhydration, and excessive LV administration to mitigate potential toxicities and compensate for inadequate monitoring facilities in peripheral centers using HDMTX.…”

Osteosarcoma Journey in India: Each Step Reveals a New Horizon!

“…The 3-year survival using a non-HDMTX protocol in osteosarcoma patients was 54.6% in a South Indian study. [7] Successive studies in another tertiary care center demonstrated 32% good responders and a 5-year survival of 50% treated with a protocol without HDMTX. [8][9][10] The "OGS-12" protocol was well tolerated with comparable toxicities.…”