Clinical Trials Role of the Surgical Oncologist

At the very heart of evidence-based medicine, and nowhere is this truer than in oncology, are clinical trials. Although the early trials initiated by the National Cancer Institute (NCI) in the mid-1970s primarily considered nonsurgical issues (leukemia, lymphoma, stage IV disease), surgeons quickly became involved in significant roles in clinical oncology trials, such as the National Surgical Adjuvant Breast Project (NSABP), which has answered, and continues to answer, many important questions regarding the optimal surgical and adjuvant therapy of breast and colon cancer. Today, most cooperative groups include surgery committees to address ongoing questions regarding the surgical management of a variety of malignancies. The prominent role of surgery in the design and implementation of clinical oncology trials is best exemplified by the establishment of the American College of Surgeons Oncology Group (ACOSOG) to evaluate the surgical management of patients with malignant solid tumors. Created in May 1998 under the leadership of Dr. Samuel Wells, the ACOSOG is 1 of 10 cooperative groups funded by the NCI to develop and coordinate multiinstitu-tional clinical trials.

As surgical oncologists, our obligation is not only to the patient who is sitting before us in the office, but to the progression of patients who will follow. The improved success and decreased morbidity of the treatments that we offer today are only possible because of the involvement of surgeons and their patients in clinical trials of the past. As the newest discoveries in all fields of oncology will have a direct impact on the surgical therapy, it is imperative that surgeons continue to play prominent roles as both leaders and participants in multidisciplinary cooperative group trials. All surgical oncologists should not only incorporate clinical trials into their practice but strongly encourage the participation of the general surgical community.

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