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Background: Anthracyclines are an important component of multiple drug chemotherapy regimens used in the treatment of osteosarcoma OGS . Limited data exists regarding early chronic anthracycline induced cardiotoxicity AIC in this young and healthy patient population. The aim as to determine the incidence and risk factors associated ith early chronic AIC in OGS patients. Methods: This is a retrospective case-control study of patients ith OGS treated ith anthracycline based chemotherapy ith curative intent from Jan 2010 to March 2013. Patients ere monitored for any decline in cardiac function using 2D- echocardiography at serial time points. Early chronic AIC as defined as a decrease in left ventricular ejection fraction LVEF by more than 20 percentage points to a value 50 percent, a decrease in LVEF by more than 10 percentage points to a value lt 50 percent, or clinical manifestations ith signs and symptoms of heart failure. Those ho developed early chronic AIC ere included as cases and those ho did not ere included as controls. Data as analyzed to determine the incidence and potential factors associated ith increased risk of symptomatic and asymptomatic early chronic AIC. Results: Three hundred to OGS patients treated ith anthracycline based chemotherapy ere included in this analysis. The median age as 17 years range 7-65 years . Of 302 patients included, 202 ere male and 100 female. The incidence of early chronic AIC as 13 percent hile the incidence of symptomatic cardiac dysfunction as 1.7 percent. The median fall in LVEF among cases as 10 percentage points range 10- 45 . Evaluation of potential risk factors revealed that hemoglobin lt 10 gmdl, albumin lt 4 gmdl, GFR lt 90 mlmin, LDH 200 UL, alkaline phosphatase 360 UL, iron 60 ugdL, ferritin 250 ngml, vitamin B12 lt 180 pgml, folate lt 1.7 ngml, BSA 1.7 m2 and BMI 25 kgm2is not associated ith increased risk of early chronic AIC. Conclusions: We conclude from this large case-control study that incidence of early chronic AIC in OGS patients is high in our setting. Risk factors for AIC in this relatively young patient population ho lack conventional risk factors for cardiotoxicity, still remain to be identified.,J Clin Oncol 34, 2016 suppl; abstr 10075 00:00.0,Patient and Survivor Care