A 15-year-old boy presents with 3 months of knee pain and a destructive metaphyseal lesion of the distal femur with Codman's triangle and sunburst appearance on X-ray. Biopsy confirms osteosarcoma. Staging reveals no metastases. What is the current standard initial treatment strategy?

• A Immediate wide surgical resection followed by adjuvant chemotherapy
• B Radiotherapy alone as primary treatment given proximity to growth plate
• C Amputation followed by chemotherapy as the only curative approach
• D Neoadjuvant (preoperative) chemotherapy followed by limb salvage surgery, then adjuvant chemotherapy ✓

Explanation

The current standard of care for high-grade osteosarcoma is neoadjuvant (preoperative) chemotherapy using MAP regimen (methotrexate, adriamycin/doxorubicin, cisplatin) for 6–12 weeks, followed by limb salvage surgery with wide resection, then adjuvant chemotherapy. Neoadjuvant chemotherapy allows assessment of histologic response (>90% necrosis = good responder, correlates with better prognosis), tumor devascularization, and time for custom prosthesis fabrication. Osteosarcoma is radioresistant, making radiotherapy ineffective as primary treatment. Limb salvage has equivalent survival to amputation when wide margins are achieved.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.