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Conventional osteogenic sarcoma is an aggressive bone tumour. High dose methotrexate-based regimen remains the cornerstone of management in osteosarcoma. However, the administration of High Dose MTX in osteosarcoma is a therapeutic challenge specially when facility for therapeutic drug monitoring is not available. Due to the practical difficulties with HD MTX, OGS 12 protocol, (a non-HD MTX) based 3 drug regimen was developed by Tata Memorial Hospital (TMH). Here, we are presenting a multicentric study on our treatment experience with OGS 12 protocol amongnon-metastatic conventional osteosarcoma of extremities. We were treating all patients presenting with non-metastatic conventional osteosarcoma of extremity patient uniformly with OGS-12 protocol over last 2 years. A total of 22 patients were treated over 2 years on OGS-12 protocol. The Initial four cycle of chemotherapy were neo-adjuvant therapy. After resection, histopathology reports were collected and 4 cycles of adjuvant chemotherapy were given. Patients were followed up for end of treatment response with imaging and treatment related complications. A total of 22 patients were studied over 2-year duration. The median age of presentation was 16 years with range (8-27). Out of them 17(72.7%) were male patients and 5(22.7%) were female patients. At the end of neo-adjuvant chemotherapy, 17 patients underwent local limb salvage procedures whereas 5 patients underwent amputation. On histopathologic evaluation, specimen was tumour free among 41.66% and necrosis >90% was reported in 25% cases. Some patient underwent intra-corporal RT where chemotherapy response could not be assessed. Chemotherapy was well tolerated with some episodes of neutropenia's without fever. There were no chemotherapy toxicity related deaths in the entire cohort. In the real-world scenario, OGS-12 protocol appear feasible and well tolerated. However, in our experience, the pathological response was inferior to the original OGS-12 study from TMH. In scenarios, where High dose methotrexate feasibility is a challenge; the OGS-12 holds some promise. However, a future refinement in multidisciplinary treatment approach in tertiary care Institutes India is warranted.
K et al. (Fri,) studied this question.