Adherence to International Clinical Practice Guidelines in the Multidisciplinary Management of Osteosarcoma in Mexico and Latin America: A Real-World Evidence Review

Abstract

Background:
Osteosarcoma is the most common primary malignant bone tumor affecting adolescents and young adults. International guidelines recommend a multidisciplinary approach based on systemic chemotherapy, complete surgical resection, and structured follow-up. However, significant barriers may limit adherence to these recommendations in low- and middle-income countries.

Objective:
To evaluate adherence to international clinical practice guidelines (NCCN, ESMO, and SELNET) in the multidisciplinary management of osteosarcoma in Mexico and Latin America and to identify barriers and opportunities for improvement.

Methods:
A systematic literature review was conducted including studies published between 2004 and 2025. PubMed, Web of Science, and Google Scholar were searched for observational studies, retrospective and prospective cohorts, institutional registries, and case series reporting clinical characteristics, treatment strategies, and outcomes.

Results:
Twenty-four Mexican studies and multiple Latin American series met inclusion criteria. Most studies were retrospective (62%), with a predominance of male patients and a peak incidence between 10 and 19 years of age. Major deviations from international recommendations included delayed diagnosis, limited access to complete MAP chemotherapy protocols, reduced relative dose intensity, delays or refusal of surgery, and treatment abandonment. Overall survival ranged from 40% to 81%, depending on disease stage and treatment accessibility.

Conclusions:
Adherence to international osteosarcoma guidelines remains heterogeneous across Mexico and Latin America. Strengthening multidisciplinary care, centralizing treatment in specialized referral centers, and developing regional clinical registries are critical strategies to improve outcomes.