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Controversies and Challenges in the Management of Osteosarcoma—an Indian Perspective

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Abstract

Osteosarcoma (OGS) is the most common primary bone tumor in children and adolescents which requires a multidisciplinary approach to management. Although chemotherapy and surgery can cure more than half of localized OGS cases, the unique challenges faced by resource-limited countries like India make this outcome difficult to achieve. Various questions in the management of OGS including role of high-dose methotrexate (HDMTX) in neoadjuvant setting, triplet vs doublet chemotherapy, intensification of chemotherapy based on response in setting of doublet, and indigenous prosthesis in setting of limb salvage need to be defined. Similarly, in the metastatic and recurrent setting, questions regarding intent of treatment, indications of chemotherapy, timing of surgery, and role of targeted therapies need clarification. Lack of randomized trials from India makes definite conclusions difficult, but an attempt can be made to define the best approach in the Indian scenario from available evidence. Hence, a critical review of literature from India and the West was done to define possible management approaches and highlight the lacuna for future research.

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Authors and Affiliations

  1. Department of Medical Oncology, DR BRAIRCH, AIIMS, New Delhi, 110029, India

    Abhenil Mittal, Deepam Pushpam, Shuvadeep Ganguly & Sameer Bakhshi

  2. Department of Orthopedics, AIIMS, New Delhi, 110029, India

    Venkatesan Sampath Kumar & Shah Alam Khan

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  1. Abhenil Mittal
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A. M., D. P., and S. B. conceptualized the manuscript; A. M., S. G., and S. B. did the review of literature; A. M., D. P., S. G., and V. S. K. wrote the manuscript. S. B. and S. A. K. reviewed the manuscript and suggested revisions. A. M., D. P., V. S. K., S. G., S. A. K., and S. B. approved the final manuscript.

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Mittal, A., Pushpam, D., Ganguly, S. et al. Controversies and Challenges in the Management of Osteosarcoma—an Indian Perspective. Indian J Surg Oncol 13, 939–955 (2022). https://doi.org/10.1007/s13193-021-01486-3

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