Does neoadjuvant chemotherapy provide a survival benefit in maxillofacial osteosarcoma: A systematic review and pooled analysis

Maxillofacial osteosarcoma (MFOS) is a rare disease that presents and behaves differently to the more commonly seen osteosarcoma (OS) of long bones. Neoadjuvant chemotherapy (neoCTx) has been shown to increase survival in OS of long bones, however it is contentious whether it has the same benefit when treating MFOS. The aim of this review was to determine whether neoCTx has a survival benefit for MFOS. Pubmed/Medline, EMBASE and CINAHL databases were searched. Of the 264 studies identified 18 were included reporting on the effect of neoCTx on survival. Individual data of 222 patients was pooled, and survival was estimated using Kaplan-Meier method and variables were assessed using Cox regression. NeoCTx had no significant effect on disease specific survival (p = 0.28). Margin status, age and grade of tumour had a significant effect on survival. This study did not find a consistent survival benefit for neoCTx over surgery as the primary treatment modality in the management of osteosarcomas of the head and neck.