How do you approach patients with lymph node positive osteosarcoma of the extremities for neoadjuvant chemotherapy?

The treatment for such patients is still the same as for any osteosarcoma. However, I would approach such patients with a mindset of dealing with metastatic disease. The fact that the lymph nodes are positive for osteosarcoma fortels of a poor prognosis (as it makes this a metastatic disease). In adults, we approach neoadjuvant therapy with the regimen of doxorubicin and cisplatin for four cycles. In children, an alternating regimen of doxorubicin-cisplatin with methotrexate is usually followed....