A 16-year-old presents with distal femoral pain and swelling. X-ray shows a mixed lytic-sclerotic lesion arising from the metaphysis with a 'sunburst' periosteal reaction and Codman's triangle. Staging CT shows no metastases. What is the standard treatment protocol?

• A Immediate wide resection followed by adjuvant chemotherapy
• B Radiation therapy alone — osteosarcoma is radiosensitive
• C Intralesional curettage with cement and chemotherapy
• D Neo-adjuvant chemotherapy (MAP regimen), then limb-salvage surgery, then adjuvant chemotherapy based on histological response ✓

Explanation

Conventional osteosarcoma is treated with the sandwich approach: neo-adjuvant chemotherapy (methotrexate, doxorubicin, cisplatin — MAP regimen) for 3 cycles to downstage the tumour and treat micrometastases, followed by limb-salvage wide resection if margins are achievable, then adjuvant chemotherapy tailored to histological response (>90% necrosis = good responder, maintain MAP; poor responder → add ifosfamide-etoposide). Osteosarcoma is radioresistant. Intralesional curettage results in near-certain local recurrence and is contraindicated in primary osteosarcoma.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.