Comparative Outcome on Tumor Necrosis of Two Versus Three Chemotherapeutic Regimens in Adult Osteosarcoma: Insight from Penang General Hospital

H Ahmad Munir, M Akmaludin, A Azid

Abstract: Standard treatment of osteosarcoma must include neoadjuvant chemotherapy followed by surgical resection and adjuvant chemotherapy. Preferred treatment as suggested by NCCN guideline include doxorubicin, cisplatin and methotrexate. Combination of cisplatin and methotrexate exerts significant toxicity and HDMTX require complex monitoring of the patients. OS - 99 study revealed that treatment containing doxorubicin, carboplatin, and ifosfamide produce comparable outcome to treatment containing HDMTX. This retrospective study compares the outcomes of tumor necrosis in adult osteosarcoma patients treated with either a two drug regimen doxorubicin and cisplatin or a three drug regimen doxorubicin, cisplatin, and ifosfamide at Penang General Hospital. The study spans from 2020 to 2024 and includes 16 patients with resectable osteosarcoma of the extremities. The results indicate no significant difference in tumour necrosis between the two regimens, with both achieving comparable outcomes. Given the similar efficacy, the two drug regimen may be preferable for older patients or those with comorbidities due to its lower toxicity.

Keywords: osteosarcoma, chemotherapy, tumour necrosis, doxorubicin, ifosfamide