Challenges facing clinical research.

President-Elect Niederhuber, members of the Executive Council, my family and my friends in surgical oncology, and future presidents of this society. . . I begin by stating my humble but profound thanks for the honor of serving as the president of this society. I am honored to be following in the footsteps of people whom I admire and many of whom I count as dear friends. This society has contributed so much to the advancement of care for patients with cancer that is more effective, more humane, and more tolerable than would otherwise be the case. To review the papers presented here over the years is to see the development of scientific care for patients with solid tumors presented by the investigators who made the difference, despite the fact that other societies may be larger or play their trumpets at greater volume. You may have noticed that I saluted future presidents of the society. In preparation for this address I read many of the addresses of former presidents. I was immediately struck by the fact that virtually all of these began by noting that the prior presidential addresses have just been read. Dr. Copeland was among those who produced tables of the prior presidential address topics and categorized them,1 as have several other presidents.2,3 As I considered this, there dawned the sad realization that the future presidents read these addresses because, like commencement speeches, these carefully wrought, elegantly phrased statements leave no imprint on the memory. One’s presidential address, like one’s funeral, requires that you be present, together with assembled friends and family. The difference is that only for the presidential address do you need a manuscript, and only what you say at your own funeral will be long remembered. Two addresses by surgeons stand out particularly in my mind above all the others I have heard. Unfortunately, what is memorable is their length. Each was so incredibly long that one passed through all of Elizabeth Kubler-Ross’s stages of grief in listening to it: denial, anger, bargaining with God, depression, and finally resignation. . . These talks so impressed me that I promise not to take that road to notoriety. If one begins by looking backward, the society has heard reports at its annual meetings of remarkable changes in the management of solid tumors over the last 25 years. Some obvious examples come to all of our minds. In breast cancer, the standard operation has changed from removal of the breast to preservation of the breast–with reconstruction for those few women who still require mastectomy. Sentinel lymph node mapping has eliminated the need for axillary dissection with its attendant morbidity for the majority of women with breast cancer. Most exciting is the declining mortality from this disease.4 In colorectal cancer, the survival benefits of adjuvant therapy are added to the survival advantage from resection of hepatic metastases for a subset of those who initially fail by tumor recurrence. Induction radiation and chemotherapy has made possible sphincter-preserving surgery for the great majority of those with rectal cancer. In the area of sarcomas, we have gone from standard amputation to standard limb-sparing procedures. In melanoma, we have seen a change from wide resection for all to narrower margins. The role of elective regional lymph node dissection was first defined, then the introduction of sentinel lymph node mapping has allowed that procedure to be performed selectively. Vaccines and biological treatments are being introduced. All of these transformations in the care of solid tumors have been made possible by clinical trials. Most of these clinical trials have been led by members of this society. This entire society has participated in these trials through membership in the National Surgical Adjuvant Breast and Bowel Program (NSABP) and in the other National Cancer Institute Cooperative Groups (CALGB, ECOG, SWOG, NCCTG), with leadership positions with breast, colorectal, melanoma, lung, and sarcoma committees of Received April 18, 2001; accepted April 30, 2001. Address correspondence and reprint requests to: William C. Wood, MD, Suite B206, Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA 30322; Fax: 404-727-4716; E-mail: william_wood@ emory.org. Annals of Surgical Oncology, 8(6):471–476 Published by Lippincott Williams & Wilkins © 2001 The Society of Surgical Oncology, Inc.