A 15-year-old presents with a painful swelling around the knee for 3 months. X-ray shows a sunburst pattern with Codman's triangle at the distal femur metaphysis. MRI shows soft tissue extension. Bone biopsy confirms osteosarcoma. The current standard neoadjuvant treatment protocol before surgery is:
- A Radiotherapy 60 Gy followed by limb-sparing surgery
- B Imatinib (tyrosine kinase inhibitor) for 3 months then surgery
- C Neoadjuvant chemotherapy (MAP protocol: Methotrexate, Doxorubicin, Cisplatin) followed by limb-salvage surgery ✓
- D Surgical amputation without chemotherapy
Explanation
The current standard for conventional osteosarcoma is neoadjuvant chemotherapy using the MAP protocol (high-dose Methotrexate, Adriamycin/doxorubicin, Cisplatin) for 6–10 weeks, followed by definitive surgery (limb-salvage in ~85% of cases), followed by adjuvant chemotherapy assessing histological response. Good responders (>90% tumor necrosis) have significantly better prognosis. Radiotherapy has limited efficacy in osteosarcoma. Imatinib is used for GIST and some sarcomas but not standard osteosarcoma. Amputation is now reserved for cases where tumor-free margins cannot be achieved.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.