The Surgery Committee makes important contributions to the NCCTG research programs in four major spheres: 1) Administration-85 new surgeons (total 162) have been recruited since the last grant cycle, allowing increasing emphasis on subspecialty contributions. The Committee has designated """"""""disease-specific"""""""" program representatives (breast, colorectal, hepatic, and thoracic) from the Research Base. A newsletter has enhanced pre- and post-meeting communications. Future efforts will focus on developing a Liaison Program to enhance """"""""disease- specific"""""""" community surgeon representation and a Direct Tailored Communication Network. 2) Scientific Contributions-Surgeons were listed as study chair (13) or co-chair (6) for a total of 19 diverse protocols in the last grant cycle, (5) Colorectal, (6) Hepatic Metastases Metastases, (2); Thoracic, (5); and Melanoma, (1). In the Breast Program, there are two protocols specifically addressing surgical questions: N9431 investigates the association between menstrual cycle phase, breast addressing surgical questions: N9431 investigates the association between menstrual cycle phase, breast cancer surgery, and disease-free survival. E5194 investigates results from local excision along for selected patients with ductal carcinoma in situ. 954-32-51 is a phase II follow-up study to the pilot studying Accelerated Hyperfractionated Radiation Therapy Following Lumpectomy and Axillary Lymph Node Dissection in Patients with Stage I/II Breast Cancer. Future plans include investigations into bone marrow analysis in breast cancer and how information on micrometastases can be used for staging and treatment. In the Colorectal Program, surgeons are study chairs on four protocols, two of which investigate independent surgical questions; 93-46-53(INT -0146) represents a unique effort to address whether laparoscopic surgery for colon cancer is oncologically is oncologically sound. 97-46-52 addresses the issue of surgeon variability in rectal cancer surgery in a community- based USA practice. Future plans include additional adjuvant studies incorporating CTP-11 and 5-FU based chemotherapy, C89803. The Hepatic Metastases Program includes two important studies, 90-46-52 and 92-46-52, testing the role of adjuvant therapy and testing the ability to extend curative resections to patients with multiple metastases using systemic plus regional chemotherapy, respectively. A future study, 97-46- 51, will study the possibility of rendering otherwise """"""""unresectable"""""""" lesions """"""""resectable"""""""" employing systemic oxaliplatin, 5-FU, and CF chemotherapy The Thoracic Program within surgery is new and promises to become active with esophageal and lung-protocols. Although most of these test surgical adjuvant therapies, one current protocol, C9334 (CALGB initiated), investigates a surgical question, whether Sclerosis of Pleural Effusions by Talc Thoracoscopy is good as Talc Slurry. NCCTG's success with 95-24-51, a phase II trial of preoperative paclitaxel and carboplatin in patients with resectable non-small cell lung cancer, puts the thoracic team in good position for future accrual to the phase III SWOG study (S9900). S9900 will test the paclitaxel/carboplatin preoperative adjuvant strategy against surgery alone. 3) Quality Assurance (QA)-In addition to surgical guidelines and a routine QL review process, unique aspects of NCCTG surgical QA include surgeon credentialing, video review audits, pre-enrollment surgical review, and standardized guidelines and data forms for colorectal cancer resulting from an NCI workshop organized by the NCCTG Surgical Scientific Coordinator. 4) Education-Symposia and workshops have become integral to the Surgery Committee meetings. Future efforts will focus on the training of new surgeons (residents in Cooperative Group activities.
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