Real world data of neoadjuvant and adjuvant chemotherapy in head neck osteosarcoma: Experience from a tertiary care center in India.

Abstract

e18012 Background: The head and neck (HN) region is a rare sub-site of osteosarcoma(OGS), with less than 10% of all cases of osteosarcoma and < 1% of all the head and neck malignancies . The evidence pertaining to the treatment of OGS of the head & neck region is limited. The role of adjuvant chemotherapy is evolving and research in this field is limited by the rarity of this tumour. However, in multiple small series, adjuvant or neoadjuvant chemotherapy has been found to be beneficial in head and neck OGS. To this end, we have audited our practice of the last 10 years to see the pattern of care, outcomes and advancements in the chemotherapy of HN OGS. Methods: We maintain a record at our outpatient department of patients receiving neoadjuvant and adjuvant chemotherapy. We conducted a database search spanning the data from 2010 to 2020, using the keywords: osteosarcoma, osteogenic sarcoma, OGS and head neck region, maxilla, skull base. Any adult patients who received chemotherapy in the adjuvant or neoadjuvant setting were selected for this study. The baseline demographics, patterns of chemotherapy administration and outcomes were documented. We analysed the data using SPSS descriptive statistical analysis. Survival analysis for progression-free survival and overall survival was done using the Kaplan-Meyer method. Results: 30 patients of HN OGS were treated with neoadjuvant chemotherapy (NACT) or adjuvant chemotherapy (ACT) at our centre from 2010 to 2020. The median age was 25 years, with a male preponderance (n = 21, 70%). The sites of disease were maxilla- 15(50%), mandible- 11 (37%), alveolus- 2 (6.6 %), orbit- 1 (3.3%), masticator space - 1 (3.3%). Out of the study population, 18 patients (60%) received NACT, 17 patients (56%) received ACT, 5(16%) patients received both NACT and ACT. 23 patients (76.6 %) underwent surgical resection, with R0 resection achieved in 17 (56.6%) and R1 in 3 patients(10%). 16 patients (53.3%) received adjuvant radiotherapy. Median progression-free survival was 16.10 months (95% CI: 10.30-21.89). Median overall survival (OS) was 22.56 months (95%CI: 11.16-33.96). 2 years OS was 49.1% (standard error 9.6). Conclusions: The patterns of use of neoadjuatnt and adjuvant chemotherapy in HN OGS are variable. Overall, the outcomes of HN OGS remain unsatisfactory. Further efforts are warranted in this direction to standardise an algorithm for chemotherapy. Further intensification of therapy may be required to improve patient outcomes.