What is your preferred neoadjuvant chemotherapy course for healthy adult patients with osteosarcoma?

This article discusses the safety & efficacy of HDMTX in young adults and shows it can be safely administered, with good supportive care. The EURO-BOSS study is also a great resource for this topic.

Because older adults do seem to tolerate HDMTX more poorly and experience markedly delayed clearance, ...

In my experience, high-dose methotrexate (12 g/m2) is poorly tolerated in adults over the age of 25 or so. I believe the data favor doxorubicin/cisplatin in the neoadjuvant setting. I am not aware of a benefit to the addition of ifosfamide in the neoadjuvant setting.

We use doxorubicin 75-90 mg/m2 by 72 hr infusion or bolus with dexrazoxane plus cisplatinum 100-120 mg/m2 over 3 hours intra-arterial when possible. Usually 4 cycles then determine postop chemotherapy based on percent necrosis.