Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients

Luke James Dotson; Kyle Warren Blackburn; Davinder Mand; Trevor Trudeau; Rashmi Agarwal; Russell Alan Ward

doi:doi:10.11648/j.jctr.20251301.12

Research Article |

| Peer-Reviewed

Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients

Luke James Dotson^*

, Kyle Warren Blackburn

, Davinder Mand

, Trevor Trudeau

, Rashmi Agarwal

, Russell Alan Ward

Published in Journal of Cancer Treatment and Research (Volume 13, Issue 1)

Received: 15 April 2025 Accepted: 27 April 2025 Published: 29 May 2025

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Abstract

Background: Neoadjuvant chemotherapy followed by surgery and subsequent adjuvant chemotherapy has been a mainstay of many osteosarcoma treatment protocols. However, the overall survival (OS) benefit over surgery and adjuvant chemotherapy is unclear. Aims: This study therefore directly compares the outcomes among these treatment groups using a large population in the National Cancer Database (NCDB). Methods: In a retrospective cross-sectional study, osteosarcoma patients in the NCDB (2004-2019) were stratified based on chemotherapy and surgery timing (neoadjuvant and adjuvant vs adjuvant-only chemotherapy). We used Kaplan-Meier curves to compare OS in the unmatched population and in a propensity score matched cohort that controlled for demographics, treatment, and tumor characteristic differences. Univariate and multivariate analyses were also used to predict the likelihood of positive margins among the population. Chi-square tests were used to compare 30- and 90-day mortality among treatment groups. P-values <0.05 were considered significant. Results: The study population included 4,659 patients: 3,733 neoadjuvant and 926 adjuvant-only chemotherapy regimens. Patients who underwent neoadjuvant therapy had significantly longer survival in the unmatched analysis (p<0.001), but this difference narrowed when controlling for covariates in the matched cohort (p=0.67). Mortality at 30 and 90 days was insignificant between treatment groups in both the full and matched cohorts (p=0.3 and p=0.9 respectively). Neoadjuvant chemotherapy regimens predominated with over 75% utilization, but this rate remained constant during the 15-year study period. Three- and five-year survival rates were relatively unchanged during this period at 75% and 62.5% respectively. Factors significantly associated with positive margins in the multivariate analysis included adjuvant-only chemotherapy (OR=1.6, p<0.001), older age (OR=1.01, p<0.001), female sex (OR=1.27, p=0.04), adjuvant radiation (OR=4.96, p<0.001), and stage IVB tumors (OR=2.11, p<0.001). Conclusions: These results indicate that neoadjuvant chemotherapy did not increase overall or short-term survival compared to adjuvant chemotherapy alone in our study. However, neoadjuvant therapy was associated with fewer positive margins at the time of surgery. These insights offer information to help clinicians evaluate osteosarcoma treatment regimens to maximize outcomes and limit treatment morbidity.

Published in	Journal of Cancer Treatment and Research (Volume 13, Issue 1)
DOI	10.11648/j.jctr.20251301.12
Page(s)	10-22
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Osteosarcoma, Chemotherapy, Survival Analysis, Margins of Excision, Morbidity, National Cancer Database (NCDB)

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APA Style

Dotson, L. J., Blackburn, K. W., Mand, D., Trudeau, T., Agarwal, R., et al. (2025). Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients. Journal of Cancer Treatment and Research, 13(1), 10-22. https://doi.org/10.11648/j.jctr.20251301.12

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ACS Style

Dotson, L. J.; Blackburn, K. W.; Mand, D.; Trudeau, T.; Agarwal, R., et al. Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients. J. Cancer Treat. Res. 2025, 13(1), 10-22. doi: 10.11648/j.jctr.20251301.12

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AMA Style

Dotson LJ, Blackburn KW, Mand D, Trudeau T, Agarwal R, et al. Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients. J Cancer Treat Res. 2025;13(1):10-22. doi: 10.11648/j.jctr.20251301.12

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@article{10.11648/j.jctr.20251301.12,
  author = {Luke James Dotson and Kyle Warren Blackburn and Davinder Mand and Trevor Trudeau and Rashmi Agarwal and Russell Alan Ward},
  title = {Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients
},
  journal = {Journal of Cancer Treatment and Research},
  volume = {13},
  number = {1},
  pages = {10-22},
  doi = {10.11648/j.jctr.20251301.12},
  url = {https://doi.org/10.11648/j.jctr.20251301.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20251301.12},
  abstract = {Background: Neoadjuvant chemotherapy followed by surgery and subsequent adjuvant chemotherapy has been a mainstay of many osteosarcoma treatment protocols. However, the overall survival (OS) benefit over surgery and adjuvant chemotherapy is unclear. Aims: This study therefore directly compares the outcomes among these treatment groups using a large population in the National Cancer Database (NCDB). Methods: In a retrospective cross-sectional study, osteosarcoma patients in the NCDB (2004-2019) were stratified based on chemotherapy and surgery timing (neoadjuvant and adjuvant vs adjuvant-only chemotherapy). We used Kaplan-Meier curves to compare OS in the unmatched population and in a propensity score matched cohort that controlled for demographics, treatment, and tumor characteristic differences. Univariate and multivariate analyses were also used to predict the likelihood of positive margins among the population. Chi-square tests were used to compare 30- and 90-day mortality among treatment groups. P-values Results: The study population included 4,659 patients: 3,733 neoadjuvant and 926 adjuvant-only chemotherapy regimens. Patients who underwent neoadjuvant therapy had significantly longer survival in the unmatched analysis (pConclusions: These results indicate that neoadjuvant chemotherapy did not increase overall or short-term survival compared to adjuvant chemotherapy alone in our study. However, neoadjuvant therapy was associated with fewer positive margins at the time of surgery. These insights offer information to help clinicians evaluate osteosarcoma treatment regimens to maximize outcomes and limit treatment morbidity.
},
 year = {2025}
}

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TY  - JOUR
T1  - Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients

AU  - Luke James Dotson
AU  - Kyle Warren Blackburn
AU  - Davinder Mand
AU  - Trevor Trudeau
AU  - Rashmi Agarwal
AU  - Russell Alan Ward
Y1  - 2025/05/29
PY  - 2025
N1  - https://doi.org/10.11648/j.jctr.20251301.12
DO  - 10.11648/j.jctr.20251301.12
T2  - Journal of Cancer Treatment and Research
JF  - Journal of Cancer Treatment and Research
JO  - Journal of Cancer Treatment and Research
SP  - 10
EP  - 22
PB  - Science Publishing Group
SN  - 2376-7790
UR  - https://doi.org/10.11648/j.jctr.20251301.12
AB  - Background: Neoadjuvant chemotherapy followed by surgery and subsequent adjuvant chemotherapy has been a mainstay of many osteosarcoma treatment protocols. However, the overall survival (OS) benefit over surgery and adjuvant chemotherapy is unclear. Aims: This study therefore directly compares the outcomes among these treatment groups using a large population in the National Cancer Database (NCDB). Methods: In a retrospective cross-sectional study, osteosarcoma patients in the NCDB (2004-2019) were stratified based on chemotherapy and surgery timing (neoadjuvant and adjuvant vs adjuvant-only chemotherapy). We used Kaplan-Meier curves to compare OS in the unmatched population and in a propensity score matched cohort that controlled for demographics, treatment, and tumor characteristic differences. Univariate and multivariate analyses were also used to predict the likelihood of positive margins among the population. Chi-square tests were used to compare 30- and 90-day mortality among treatment groups. P-values Results: The study population included 4,659 patients: 3,733 neoadjuvant and 926 adjuvant-only chemotherapy regimens. Patients who underwent neoadjuvant therapy had significantly longer survival in the unmatched analysis (pConclusions: These results indicate that neoadjuvant chemotherapy did not increase overall or short-term survival compared to adjuvant chemotherapy alone in our study. However, neoadjuvant therapy was associated with fewer positive margins at the time of surgery. These insights offer information to help clinicians evaluate osteosarcoma treatment regimens to maximize outcomes and limit treatment morbidity.

VL  - 13
IS  - 1
ER  -

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Author Information

Luke James Dotson

School of Medicine, Baylor College of Medicine; Houston, USA

Contact Email

http://orcid.org/0000-0001-8167-7985
Kyle Warren Blackburn

School of Medicine, Baylor College of Medicine; Houston, USA

Contact Email

http://orcid.org/0000-0002-1384-884X
Davinder Mand

Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, USA

Contact Email

http://orcid.org/0000-0002-5599-8600
Trevor Trudeau

School of Medicine, Baylor College of Medicine; Houston, USA

Contact Email

http://orcid.org/0009-0005-6270-346X
Rashmi Agarwal

Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, USA

Contact Email

http://orcid.org/0000-0001-7759-2030
Russell Alan Ward

Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, USA

Contact Email

http://orcid.org/0000-0002-8109-5691

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Plain Text BibTeX RIS

APA Style

Dotson, L. J., Blackburn, K. W., Mand, D., Trudeau, T., Agarwal, R., et al. (2025). Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients. Journal of Cancer Treatment and Research, 13(1), 10-22. https://doi.org/10.11648/j.jctr.20251301.12

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ACS Style

Dotson, L. J.; Blackburn, K. W.; Mand, D.; Trudeau, T.; Agarwal, R., et al. Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients. J. Cancer Treat. Res. 2025, 13(1), 10-22. doi: 10.11648/j.jctr.20251301.12

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AMA Style

Dotson LJ, Blackburn KW, Mand D, Trudeau T, Agarwal R, et al. Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients. J Cancer Treat Res. 2025;13(1):10-22. doi: 10.11648/j.jctr.20251301.12

Copy | Download

@article{10.11648/j.jctr.20251301.12,
  author = {Luke James Dotson and Kyle Warren Blackburn and Davinder Mand and Trevor Trudeau and Rashmi Agarwal and Russell Alan Ward},
  title = {Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients
},
  journal = {Journal of Cancer Treatment and Research},
  volume = {13},
  number = {1},
  pages = {10-22},
  doi = {10.11648/j.jctr.20251301.12},
  url = {https://doi.org/10.11648/j.jctr.20251301.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20251301.12},
  abstract = {Background: Neoadjuvant chemotherapy followed by surgery and subsequent adjuvant chemotherapy has been a mainstay of many osteosarcoma treatment protocols. However, the overall survival (OS) benefit over surgery and adjuvant chemotherapy is unclear. Aims: This study therefore directly compares the outcomes among these treatment groups using a large population in the National Cancer Database (NCDB). Methods: In a retrospective cross-sectional study, osteosarcoma patients in the NCDB (2004-2019) were stratified based on chemotherapy and surgery timing (neoadjuvant and adjuvant vs adjuvant-only chemotherapy). We used Kaplan-Meier curves to compare OS in the unmatched population and in a propensity score matched cohort that controlled for demographics, treatment, and tumor characteristic differences. Univariate and multivariate analyses were also used to predict the likelihood of positive margins among the population. Chi-square tests were used to compare 30- and 90-day mortality among treatment groups. P-values Results: The study population included 4,659 patients: 3,733 neoadjuvant and 926 adjuvant-only chemotherapy regimens. Patients who underwent neoadjuvant therapy had significantly longer survival in the unmatched analysis (pConclusions: These results indicate that neoadjuvant chemotherapy did not increase overall or short-term survival compared to adjuvant chemotherapy alone in our study. However, neoadjuvant therapy was associated with fewer positive margins at the time of surgery. These insights offer information to help clinicians evaluate osteosarcoma treatment regimens to maximize outcomes and limit treatment morbidity.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Comparing the Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy for Osteosarcoma Patients

AU  - Luke James Dotson
AU  - Kyle Warren Blackburn
AU  - Davinder Mand
AU  - Trevor Trudeau
AU  - Rashmi Agarwal
AU  - Russell Alan Ward
Y1  - 2025/05/29
PY  - 2025
N1  - https://doi.org/10.11648/j.jctr.20251301.12
DO  - 10.11648/j.jctr.20251301.12
T2  - Journal of Cancer Treatment and Research
JF  - Journal of Cancer Treatment and Research
JO  - Journal of Cancer Treatment and Research
SP  - 10
EP  - 22
PB  - Science Publishing Group
SN  - 2376-7790
UR  - https://doi.org/10.11648/j.jctr.20251301.12
AB  - Background: Neoadjuvant chemotherapy followed by surgery and subsequent adjuvant chemotherapy has been a mainstay of many osteosarcoma treatment protocols. However, the overall survival (OS) benefit over surgery and adjuvant chemotherapy is unclear. Aims: This study therefore directly compares the outcomes among these treatment groups using a large population in the National Cancer Database (NCDB). Methods: In a retrospective cross-sectional study, osteosarcoma patients in the NCDB (2004-2019) were stratified based on chemotherapy and surgery timing (neoadjuvant and adjuvant vs adjuvant-only chemotherapy). We used Kaplan-Meier curves to compare OS in the unmatched population and in a propensity score matched cohort that controlled for demographics, treatment, and tumor characteristic differences. Univariate and multivariate analyses were also used to predict the likelihood of positive margins among the population. Chi-square tests were used to compare 30- and 90-day mortality among treatment groups. P-values Results: The study population included 4,659 patients: 3,733 neoadjuvant and 926 adjuvant-only chemotherapy regimens. Patients who underwent neoadjuvant therapy had significantly longer survival in the unmatched analysis (pConclusions: These results indicate that neoadjuvant chemotherapy did not increase overall or short-term survival compared to adjuvant chemotherapy alone in our study. However, neoadjuvant therapy was associated with fewer positive margins at the time of surgery. These insights offer information to help clinicians evaluate osteosarcoma treatment regimens to maximize outcomes and limit treatment morbidity.

VL  - 13
IS  - 1
ER  -

Copy | Download