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CTOS: CTOS: A Herman Suit LegacyA Herman Suit Legacy
Michael A. Simon, MDMichael A. Simon, MD
The University of ChicagoThe University of Chicago
Herman Suit MD MSc. PhDAndres Soriano Professor
Department of Radiation OncologyHarvard Medical School
Chief, Department of Radiation Oncology, Massachusetts General Hospital
Surgery and Radiation Therapy for Soft Tissue Sarcoma became standard
• Limb salvage rate increased from Limb salvage rate increased from
50%50% 90-95%90-95%
• No compromise in survival No compromise in survival
1975 -1985 Advances
Suit Founded Connective TissueSuit Founded Connective TissueOncology Society (CTOS) Oncology Society (CTOS)
• 1993 - 1994 Planning Meetings1993 - 1994 Planning Meetings
• 1995 - CTOS Founded 1995 - CTOS Founded
• 1997 - CTOS Incorporated1997 - CTOS Incorporated
1993 – 19941993 – 1994
New England Journal of Medicine
November 1974
The New England Journal Of Medicine
Amputation and Adriamycin in Primary Osteosarcoma
E. P. Cortes, J.F. Holland, J. J. Wang, L. F. Sinks, J. Blom, H. Senn, A. Bank, O. Glidewell
New England Journal of Medicine
December 1974
1975 -1985 1975 -1985 Advances
Musculoskeletal Tumor Society (MSTS)
performed multi-institutional studies on:
• Biopsy - Mankin Biopsy - Mankin
• Staging - Enneking Staging - Enneking
• Limb salvage - Simon Limb salvage - Simon
Limb salvage & Neoadjuvant chemotherapy established for Osteosarcoma and Ewings
• Limb salvage rate increased from Limb salvage rate increased from α 5 -10%5 -10% α 90-95%90-95%
• Osteosarcoma survival rate increased fromOsteosarcoma survival rate increased from
α 20% 20% α 65% 65%
• Ewings Sarcoma survival rate increased Ewings Sarcoma survival rate increased from from
α 5 -10% 5 -10% α 65%65%
1975 -1985 Advances
• CT Lungs
–Staging
–Thoracotomy decisions/planning
• MRI of Limbs
–Limb salvage predictable and safe
1980 -1990 Huge Imaging Advances
1975 -1990 Surgical Advances in Skeletal
Reconstruction
• Allograft and/or Prosthetic reconstruction for skeletal defects in bone sarcomas
1990 – Present1990 – Present
What progress has been made
in the last 15 years when compared to 1975-1990?
• Surgery – skeletal reconstruction on allograft vs.
prosthetic replacement for bone sarcomas
• Radiation Therapy for Soft Tissue Sarcomas– pre-op vs. post operative RT
• Medical Oncology for Bone Sarcomas– dose intensity– combination changes
1990 – Present: 1990 – Present: Perfecting Current TechniquesPerfecting Current Techniques
Where do we go from here?Where do we go from here?
• Need new paradigms of care Need new paradigms of care – Targeted Therapy Targeted Therapy
– Differentiation TherapyDifferentiation Therapy
• Need unified national organization to Need unified national organization to support large clinical trials support large clinical trials
Mission:Mission: ……to advance the care of patients with connective
tissue tumors and to increase knowledge of all aspects of the biology of these tumors, including basic and clinical research. .
CTOS & MSTS: Similar Missions
Founded 1993-1994 Multidisciplinary membership400 members from 30 countries
CTOS & MSTS: Similar Missions
Mission:
…to advance the science of orthopaedic oncology and to promote high standards of patient care. It does this through excellence in education and research and through advocacy on behalf of patients and orthopaedic oncologists.
Founded 1975 Membership: Orthopaedic Surgeons125 Members from North America
CTOS & MSTS Overlap in:
MissionMissionMembers Members LeadershipLeadershipFunding Funding
Resources Resources
MSTS & CTOS Should Consider: • Collaborating• Uniting• Merging
If both patients and members are our constituency than….
CTOS Formed 1993-1994
• MSTS remained primarily an orthopaedic surgery society
•1993-1994 Suit forms CTOS
• Interesting confluence
Barriers to CTOS / MSTS Barriers to CTOS / MSTS CollaborationCollaboration
• Leadership (Executives and Committees)
• Leadership changes & personal dynamics within organization
• Members
• Differences in resources
• Name/Identity
Accomplish Vision & Mission of CTOS / MSTS
• Constant meeting of leadership
• Have adjacent meetings
CTOS / MSTS collaboration is best for CTOS / MSTS collaboration is best for our patients our patients andand members members
Will Require Will Require Unselfish,Unselfish, VisionaryVisionary Leaders Leaders