Professor Cancer Institute (WIA) Chennai, Tamil Nadu, India
Objective: Introduction Osteosarcoma is a matrix producing neoplasm. Most patients are treated with neoadjuvant chemotherapy (NACT. Various parameters are available for response assessment which include radiological and histological criteria. Data on clinical response such as pain response and size assessment is meagre. In this study we aimed to analyze if clinical assessment used for response evaluation can predict prognosis in patients receiving neoadjuvant chemotherapy for extremity osteosarcoma.
Methods: All patients diagnosed to have osteosarcoma and who underwent treatment with curative intent between January 2000 and December 2018 were identified. Patients who had progression were identified and whether clinical progression impacted overall survival (OS) and disease free survival (DFS) was analyzed.
Results: 43 patients who had progression on NACT were identified. When compared to patients who did not have clinical progression, more patients in the clinical progression group had large tumours (p = 0.025), majority underwent amputation (p = < 0.001) and most were poor responders to chemotherapy (p = 0.011). Clinical progression on NACT predicted poor OS and DFS on univariate analysis but not on multivariate analysis.
Conclusion: Although patients with clinical progression had poor oncological outcomes, it was not a statistically significant factor affecting oncological outcomes. The role of continuing the same chemotherapy regimen in the adjuvant setting in this subset of patients is doubtful. Large multicentric studies are needed to know the prognostic impact of clinical progression during NACT on oncological outcomes.
