CTOS: A Herman Suit Legacy Michael A. Simon, MD The University of Chicago

Herman Suit MD MSc. PhD Andres Soriano Professor Department of Radiation Oncology Harvard 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 fromLimb salvage rate increased from 50%  90-95% 50%  90-95% No compromise in survivalNo compromise in survival Advances

Suit Founded Connective Tissue Oncology Society (CTOS) Planning Meetings Planning Meetings CTOS Founded CTOS Founded CTOS Incorporated CTOS Incorporated 1993 – 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

Advances Musculoskeletal Tumor Society (MSTS) performed multi-institutional studies on: Biopsy - MankinBiopsy - Mankin Staging - EnnekingStaging - Enneking Limb salvage - SimonLimb salvage - Simon

Limb salvage & Neoadjuvant chemotherapy established for Osteosarcoma and Ewings Limb salvage rate increased fromLimb salvage rate increased from 5 -10%  90-95% α 5 -10%  α 90-95% Osteosarcoma survival rate increased fromOsteosarcoma survival rate increased from 20%  65% α 20%  α 65% Ewings Sarcoma survival rate increased fromEwings Sarcoma survival rate increased from 5 -10%  65% α 5 -10%  α 65% Advances

Thoracotomy cures overall about 10% of Osteosarcoma patients Advances

CT Lungs – –Staging – –Thoracotomy decisions/planning MRI of Limbs – –Limb salvage predictable and safe Huge Imaging Advances

Surgical Advances in Skeletal Reconstruction Allograft and/or Prosthetic reconstruction for skeletal defects in bone sarcomas

1990 – Present What progress has been made in the last 15 years when compared to ?

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: Perfecting Current Techniques

Where do we go from here? How do we advance care of patients with sarcoma?

Where do we go from here? Need new paradigms of careNeed new paradigms of care –Targeted Therapy –Differentiation Therapy Need unified national organization to support large clinical trialsNeed unified national organization to support large clinical trials

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 Multidisciplinary membership 400 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 Surgeons 125 Members from North America

CTOS & MSTS Overlap in: MissionMembersLeadershipFundingResources

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 (M.A. Simon) Society too small Not multidisciplinary

CTOS Formed MSTS remained primarily an orthopaedic surgery society Suit forms CTOS Interesting confluence

Barriers to CTOS / MSTS Collaboration 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 our patients and members Will Require Unselfish, Visionary Leaders

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