Which chemotherapy drug combination constitutes the standard neoadjuvant and adjuvant regimen for classical osteosarcoma of bone?

• A VAC protocol: Vincristine, Actinomycin-D, and Cyclophosphamide
• B VIDE protocol: Vincristine, Ifosfamide, Doxorubicin, and Etoposide
• C R-CHOP: Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone
• D MAP protocol: Methotrexate (high-dose), Adriamycin (doxorubicin), and Cisplatin ✓

Explanation

The MAP protocol — high-dose Methotrexate with leucovorin rescue, Adriamycin (doxorubicin), and Cisplatin — is the international standard for neoadjuvant and adjuvant chemotherapy of high-grade osteosarcoma, yielding 5-year survival of 60–70% in localised disease. VAC and VIDE protocols are used for Ewing's sarcoma. R-CHOP is for B-cell lymphomas.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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