Dose intensity and clinical outcomes across age groups in high-grade osteosarcoma treated with methotrexate, adriamycin, and cisplatin therapy.

Authors

Bunpei Miyazaki, Yuki Kojima, Miho Nakajima, Koichi Ogura, Shintaro Iwata, Eisuke Kobayashi, Kazuki Sudo, Tatsunori Shimoi, Akihiko Yoshida, Ayumu Arakawa, Akira Kawai, Kan Yonemori

Published in

Japanese journal of clinical oncology. Jul 26, 2026. Epub Jul 26, 2026.

Abstract

The importance of maintaining planned dose intensity (DI) of methotrexate (MTX), adriamycin, and cisplatin (MAP) chemotherapy in high-grade osteosarcoma has been highlighted in clinical trials. However, DI is frequently reduced in routine practice, particularly in adults, and its prognostic relevance in real-world settings remains unclear.
We retrospectively analysed patients with high-grade osteosarcoma treated with MAP at a single center between 2014 and 2021, stratifying patients into pediatric (PED; ≤19 years), young adult (YA; 20-39 years), and older adult (OA; ≥40 years) groups. Treatment intensity was assessed using intended dose per cycle, cumulative dose over 200 days, and relative DI. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis and Cox proportional hazards models.
Among 78 patients who received MAP therapy, 51 were eligible for analysis. The 3-year PFS was 61.1% (95% CI, 45.5-73.5), with no significant difference among age groups. Higher DI was not consistently associated with improved PFS or OS; metastasis at diagnosis was the only independent prognostic factor. Treatment completion rates were similar in PED and YA patients (72% and 69%, respectively) but markedly lower in OAs (22%). Delayed MTX elimination occurred more frequently in OAs.
In this real-world cohort, reductions in chemotherapy delivery-particularly in OAs-were common; however, higher DI was not consistently associated with better survival outcomes. These findings highlight the complexity of interpreting DI metrics and support age-adapted treatment considerations.

PMID:
42502976
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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