Background. This present study aimed to assess if clinical, laboratory and MRI were an accurate benchmark in assessing the effectiveness of neoadjuvant chemotherapy in osteosarcoma patients. Methods. This was an observational analytic study with a cross-sectional design. Research subjects were selected using the total sampling method from osteosarcoma patients who underwent neoadjuvant chemotherapy during the period between January 2017– July 2019. Results.Of the 58 patients included in this study, 38 were male and 20 were female aged 5 - 67 years (mean,16-year-old. 37(63.8%) patients underwent neoadjuvant chemotherapy with CAI regimens and 13 (36.2%) with CA. The tumors were classified as stage IIB in 43 (74.1%) patients and stage III in15 (25.9%) patients. After undergoing neoadjuvant chemotherapy, 4 patients had poor MSTS, 30 patients had fair MSTS, 17  and 7 patients had good and excellent MSTS score, respectively. Spearman’s test revealed no correlation between tumor necrosis after neoadjuvant chemotherapy with a reduction in tumor size and MSTS score. Wilcoxon test showed significant differences between ALP, ESR, and NLR before and after neoadjuvant chemotherapy in the poor-response group. We found no significant difference between LDH and LMR before and after neoadjuvant chemotherapy in the good-response group. We had 9 patients for ADC value only. No significant statistical differences were found in tumor volumes after chemotherapy in both groups. Conclusion. We demonstrated that ALP level after neoadjuvant chemotherapy was markedly decreased, and was statistically significant in the poor-response group. We also demonstrated that LDH value before neoadjuvant chemotherapy had a strong correlation with degree of necrosis and could be used as a predictive indicator. NLR and LMR cannot be independent prognostic factors. MRI plays an important role in evaluating tumor volumes and preoperative radiological changes, using DWI and water diffusion to predict histological necrosis.

Data Collection

This was an observational analytic study with a cross-sectional design. The study was conducted in a tertiary referral hospital, in Jakarta, Indonesia. The study had been approved by the ethical committee of our institution with Approval No. 0055/ UN2.F1 / ETIK / 2019; and had obtained research permission from CMH Research Committee.

Research subjects were selected using the total sampling method from osteosarcoma patients who underwent neoadjuvant chemotherapy during the period between January 2017 – July 2019. Fifty-eight osteosarcoma patients with the mean age of 16 years (range was 5-67 years) were included in this study. Informed consent was obtained from all the patients or through their parents (in the pediatric patients) prior to their enrollment in this study.

The inclusion criteria in the study consisted of patients who were diagnosed with osteosarcoma as regards clinicopathological conference (CPC); and who underwent 3 cycles of neoadjuvant chemotherapy. They had complete clinical evaluation [pain and musculoskeletal tumor society score (MSTS)], laboratory and radiologic examinations [magnetic resonance imaging (MRI) before and after neoadjuvant chemotherapy)];and histopathological results before and after surgery (percentage of tumor necroses as regards Huvos grading. Neoadjuvant chemotherapy regimens were adjusted with our institution using cisplatin, adriamycin, and iphosphamide (CAI) for pediatric patients (< 18 years old) and cisplatin and adriamycin (CA) for adult patients.

After neoadjuvant chemotherapy was completed, a patient would have a limb salvage surgery or limb ablation. Surgically removed specimens were sent to the musculoskeletal pathologist for evaluation of grading of tumor cell necrosis,using the Huvos classification. Huvos grade I was consistent with less than 50% necroses; grade II with 50-90% necroses; grade III with more than 90-99% necroses; and grade IV with 100% necroses (no viable tumor cells). In our study, we grouped the results of the Huvos grading into two categories: grade III and IV were described as good-responsegroup while grade I and II as poor-response group.

Statistical analysis

Statistical analysis was performed using Mann-Whitney U test for the unpaired group and Wilcoxon test for variables in the paired group. Spearmen’s test was used to correlate between the variables. All statistical analyses were performed using SPSS software version 23.0. A p value of<0.05 was considered statistically significant.