The MAP protocol used in the neo-adjuvant treatment of osteosarcoma consists of which combination?

• A Methotrexate, Actinomycin-D and Paclitaxel
• B Methotrexate, Adriamycin (doxorubicin) and Cisplatin ✓
• C Mechlorethamine, Adriamycin and Prednisolone
• D Mitomycin, Avastin and Paclitaxel

Explanation

The MAP regimen — high-dose Methotrexate (with leucovorin rescue), Adriamycin (doxorubicin), and cisPlatin — is the standard neo-adjuvant and adjuvant chemotherapy protocol for osteosarcoma. Neo-adjuvant chemotherapy is given for 8–12 weeks before surgery; histological response (Huvos grade III/IV = >90% necrosis) is the most important prognostic factor after surgery. Poor responders may have regimen modified to include ifosfamide and etoposide. MAP dramatically improved 5-year survival from <20% (surgery alone) to ~60–70%.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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