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

Journal of Bone and Joint Surgery April 1976

Cancer May 1973

Cancer October 1977

Cancer October 1981

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

Journal of Bone and Joint Surgery

April 1970

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

Cancer January 1976

Journal Bone and Joint Surgery 1986

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

Thoracotomy cures overall about 10% of

Osteosarcoma patients

1975 -1990 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?

How do we advance care of

patients with sarcoma?

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

Who is our constituency?

Members

Patients

Leaders

MSTS & CTOS Should Consider: • Collaborating• Uniting• Merging

If both patients and members are our constituency than….

MSTS Presidential Address

1992-1993 (M.A. Simon)

• Society too small

• Not multidisciplinary

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

 

One day the vision of Dr. Suit and patients will be realized…