Objective To evaluate the efficacy and safety of polyethylene glycol liposome doxorubicin ( PLD) in the treatment of osteosareoma. Methods This study was a single-center retrospective clinical study. Two hundreds and seventy-six classical osteosarcoma treated in Beijing Jishuitan Hospital from 2015 to 2016 were enrolled. There were 213 patients who received combined chemotherapy of high dose methotrexate, ifosfamide, cisplatin and doxorubicin ( ADM) were classified in ADM group. Other 63 patients received the same types, doses and cycles of chemotherapy drugs except ADM replaced by PLD were identified as PLD group. Clinical and imaging evaluation and surgical treatment were performed after neoadjuvant chemotherapy. Tumor necrosis rate was examined according to Huvos method. The efficacy of neoadjuvant chemotherapy was evaluated based on 90%· necrosis rate. The recurrence, metastasis and survival were followed up regularly after operation. The adverse reactions of hematology, hepatorenal toxicity, gastrointestinal reaction and canliotoxicity were evaluated. Results There were no significant differences between PLD group and ADM group in age, sex, location, stage and surgical margin ( aII P>0.05). There were no significant differences in clinical symptoms and imaging evaluation between PLD group and ADM group after preoperative chemotherapy ( a.II P> 0. 05 ) . The tumor necrosis rate was detected in 134 cases. Among 27 cases of PLD group., tumor necrosis rates more than 90%, were 11 cases, while among 107 cases of ADM group., tumor necrosis rates more than 90%, were 45 cases. No significant differance of tumor necrosis rate between this two group was observed (P=0.901). The recuirrence rates of PLD group,md ADM group were 7.8% ( 4/51),md 7 .3%, ( 121164), the metastasis rates were 19. 6% ( I 0/5 I ) and I 6. 5% ( 27/ 164), the median progression free survival ( PFS) were 42 and 37 months, respectively, without significant differences ( all P>0.05). The incidence of granulopyopenia and decrease degree of grmntloq1es in PLO group were significantly lower than those in ADM group ( P < 0. 001 ) . There were no significant differences in the incidences of thrombocytopcnia, anemia, gastrointestinal reaction, liver function damage and stomatitis between two groups (all P>0.05). Conclusions PLO and ADM have similar chemotherapeutic effects in osteosarcoma. The incidences of adverse reactions of PLO arc lower, especially the hematological toxicity represented by granulocyponia is significantly reduced. PLO has a better application prospect. [ABSTRACT FROM AUTHOR]