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

2. Herman Suit MD MSc. PhD Andres Soriano Professor Department of Radiation Oncology Harvard Medical School Chief, Department of Radiation Oncology, Massachusetts General Hospital

3. Journal of Bone and Joint Surgery April 1976

8. Cancer May 1973

9. Cancer October 1977

10. Cancer October 1981

11. 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 1975 -1985 Advances

12. Suit Founded Connective Tissue Oncology Society (CTOS) 1993 - 1994 Planning Meetings1993 - 1994 Planning Meetings 1995 - CTOS Founded1995 - CTOS Founded 1997 - CTOS Incorporated1997 - CTOS Incorporated 1993 – 1994

13. Journal of Bone and Joint Surgery April 1970

15. 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

16. Cancer January 1976

23. Journal Bone and Joint Surgery 1986

26. 1975 -1985 1975 -1985 Advances Musculoskeletal Tumor Society (MSTS) performed multi-institutional studies on: Biopsy - MankinBiopsy - Mankin Staging - EnnekingStaging - Enneking Limb salvage - SimonLimb salvage - Simon

27. 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% 1975 -1985 Advances

28. Thoracotomy cures overall about 10% of Osteosarcoma patients 1975 -1990 Advances

29. CT Lungs – –Staging – –Thoracotomy decisions/planning MRI of Limbs – –Limb salvage predictable and safe 1980 -1990 Huge Imaging Advances

42. 1975 -1990 Surgical Advances in Skeletal Reconstruction Allograft and/or Prosthetic reconstruction for skeletal defects in bone sarcomas

49. 1990 – Present What progress has been made in the last 15 years when compared to 1975-1990?

50. 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

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

52. 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

53. 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 membership 400 members from 30 countries

54. 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

55. CTOS & MSTS Overlap in: MissionMembersLeadershipFundingResources

56. Who is our constituency? Members Patients Leaders

57. MSTS & CTOS Should Consider: Collaborating Uniting Merging If both patients and members are our constituency than….

58. MSTS Presidential Address 1992-1993 (M.A. Simon) Society too small Not multidisciplinary

59. CTOS Formed 1993-1994 MSTS remained primarily an orthopaedic surgery society 1993-1994 Suit forms CTOS Interesting confluence

60. Barriers to CTOS / MSTS Collaboration Leadership (Executives and Committees) Leadership changes & personal dynamics within organization Members Differences in resources Name/Identity

61. Accomplish Vision & Mission of CTOS / MSTS Constant meeting of leadership Have adjacent meetings

62. CTOS / MSTS collaboration is best for our patients and members Will Require Unselfish, Visionary Leaders

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