A case of histopathologically high-grade osteosarcoma of the maxilla with steady outcome treated according to chemotherapy protocol NECO95J

Abstract

The treatment of osteosarcoma arising in the jaw bone remains challenging. Neoadjuvant chemotherapy for osteosarcoma95J （NECO95J） is a treatment protocol developed and evaluated in Japan and its good efficacy has been reported. In this paper, we report a case of pathologically high-grade maxillary osteosarcoma treated according to the NECO95J protocol.
A 52-year-old man was referred to our hospital seeking treatment for swelling and pain on his left hard palate. Relatively well-circumscribed, elastic hard swelling （46×37mm） was observed on his left hard palate. Radiological assessment with computed tomography revealed a poorly-marginated amorphous mass including high and low density in the left hard palate extending to the left maxillary sinus. A biopsy was carried out and a histopathological diagnosis of osteosarcoma （chondroblastic type, high malignancy grade） was obtained.
The patient was treated according to multi-modal treatment including pre- and post-operative chemotherapy （NECO95J）. Firstly, the patient underwent induction chemotherapy of high-dose methotrexate, cisplatin, and doxorubicin. After radical resection of the tumor, high-dose ifosfamide （IFO） was added, because the induction chemotherapy was assessed as not effective. The patient experienced several severe adverse events, but the chemotherapy was almost accomplished as planned except for the last two doses of IFO. The patient showed no evidence of recurrence or metastasis during six years of follow-up.