2026 Proffered Presentations
S206: TREATMENT OUTCOMES IN OSTEOSARCOMA OF THE HEAD AND NECK: A SYSTEMATIC REVIEW AND META-ANALYSIS
Angela Magri, MDCMc; Emily Kay-Rivest, MDCM, MSc; Marco Mascarella, MDCM, PhD; McGill University
Background: Head and neck osteosarcomas (HNOS) are rare, accounting for approximately 1% of all head and neck malignancies. Surgery remains the primary modality of treatment; however, achieving negative margins is often limited by the proximity of neurovascular structures. The aim of this study was to systematically evaluate the impact of chemotherapy and radiotherapy, including their neoadjuvant and adjuvant use alongside surgery, on patient outcomes in HNOS.
Methods: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines across Medline, Embase, CINAHL, Scopus, Cochrane Central, and Web of Science Core Collection. 31 studies published between 1980–2025 were included. Treatment modalities included surgery (S) with or without chemotherapy (CTX) or radiotherapy (RTX), as well as timing of adjuvant versus neoadjuvant therapy. Outcomes of interest were overall survival (OS) and disease-free survival (DFS).
Results: A total of 2,006 patients were included (52.0% male; weighted mean age 38.6 years). The most common tumor sites were the jaw (mandible/maxilla) (n=1063) and skull base (n=757). Patients with jaw tumors had superior overall survival compared to skull base tumors (median 2.25 vs 1.50 years; 5-year OS 25.9% vs 9.1%; p = 0.015). Patients receiving any CTX had significantly improved OS compared to surgery alone (HR 0.75, 95% CI 0.62–0.89), with the strongest benefit seen in neoadjuvant (HR 0.55, 95% CI 0.41–0.76) and combined neoadjuvant plus adjuvant settings (HR 0.65, 95% CI 0.51–0.85). RTX, whether alone or combined with CTX, did not confer survival benefit. For DFS, any patient receiving CTX showed significant survival improvement compared to surgery only (HR 0.79, 95% CI 0.63–0.98), with neoadjuvant CTX (HR 0.55 95% CI 0.37–0.82) and adjuvant CTX (HR 0.67 95% CI 0.48–0.92) also being associated with improved outcomes.
Conclusion: While surgery remains the cornerstone for local control, systemic therapy in combination with surgery offers improved OS and DFS while the use of radiotherapy showed no benefit. These findings reinforce the importance of chemotherapy as a standard component of curative-intent therapy for HNOS.
