Photo of John O. Schorge,

John O. Schorge

Massachusetts General Hospital

Massachusetts General Hospital
Phone: (617) 724-6899
Fax: (617) 724-6898


jschorge@partners.org

John O. Schorge

Massachusetts General Hospital

EDUCATIONAL TITLES

  • Associate Professor, Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
  • Chief, Gynecologic Oncology, OB/GYN, Massachusetts General Hospital

DF/HCC PROGRAM AFFILIATION

Research Abstract

Primary debulking surgery for advanced ovarian cancer: the past, present or future?

Schorge JO, Growdon WG, Munro EG, Del Carmen MG, Boruta DM, Goodman AK. MGH Gynecologic Oncology, Boston

Objective: The efficacy of primary debulking surgery (PDS) for ovarian cancer was initially demonstrated in New England in the late 1970s and became standard of care. More recently, neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS) has been increasingly championed. We reviewed our experience with newly diagnosed advanced ovarian cancer in order to determine our provision of care.

Methods: We prospectively collected data on all women with newly diagnosed stage IIIC/IV epithelial ovarian cancer who underwent primary therapy at MGH from 5/08-5/09. Pathology was reviewed and treatment planning discussed at our weekly multidisciplinary tumor board conference.

Results: 42 patients were treated having a median age of 62 years. 31 patients had stage IIIC disease and 32 had pap serous histology. 35 women (83%) underwent PDS and 7 NACT with IDS. Overall, 64% were optimally debulked to < 1 cm residual disease and there was a trend toward a lower rate in PDS patients (60 v 86%; P = 0.39). Debulking surgery involved lymphadenectomy (31%), bowel resection (29%), splenectomy (17%), and diaphragmatic surgery (14%). Major postoperative morbidity was comparable between PDS and NACT/IDS patients (40 v 28%; P = 0.69). The median day of discharge was 8 (range, 3-28). 11 women (26%) were enrolled in a clinical trial.

Conclusions: Both PDS and NACT/IDS have a role in the initial treatment of women with advanced epithelial ovarian cancer. We hope our data will stimulate discussion of current practice in New England.

 

Publications

Powered by Harvard Catalyst
  • Rauh-Hain JA, Connor SC, Clemmer JT, Foley OW, Clark RM, Hall TR, Boruta DM, Schorge JO, Del Carmen MG. Trends in Treatment of Uterine Serous Cancer in the Medicare Population. Int J Gynecol Cancer 2015; 25:1023-30. PubMed
  • Rauh-Hain JA, Hariton E, Clemmer J, Clark RM, Hall T, Boruta DM, Schorge JO, Del Carmen MG. Incidence and effects on mortality of venous thromboembolism in elderly women with endometrial cancer. Obstet Gynecol 2015; 125:1362-70. PubMed
  • Aviki EM, Rauh-Hain JA, Clark RM, Hall TR, Berkowitz LR, Boruta DM, Growdon WB, Schorge JO, Goodman A. Gynecologic Oncologist as surgical consultant: Intraoperative consultations during general gynecologic surgery as an important focus of gynecologic oncology training. Gynecol Oncol 2015; 137:93-7. PubMed
  • Rauh-Hain JA, Buskwofie A, Clemmer J, Boruta DM, Schorge JO, Del Carmen MG. Racial disparities in treatment of high-grade endometrial cancer in the medicare population. Obstet Gynecol 2015; 125:843-51. PubMed
  • Joseph N, Clark RM, Dizon DS, Lee MS, Goodman A, Boruta D, Schorge JO, Del Carmen MG, Growdon WB. Delay in Chemotherapy Administration Impacts Survival in Elderly Patients with Epithelial Ovarian Cancer. Gynecol Oncol 2015. PubMed
  • Foley OW, Rauh-Hain JA, Clemmer J, Clark RM, Hall T, Diver EJ, Schorge JO, del Carmen MG. Trends in the treatment of uterine leiomyosarcoma in the Medicare population. Int J Gynecol Cancer 2015; 25:453-8. PubMed
  • Clark RM, Lee MS, Alejandro Rauh-Hain J, Hall T, Boruta DM, Del Carmen MG, Goodman A, Schorge JO, Growdon WB. Surgical Apgar Score and prediction of morbidity in women undergoing hysterectomy for malignancy. Gynecol Oncol 2015; 136:516-20. PubMed
  • Rauh-Hain JA, Melamed A, Buskwofie A, Schorge JO. Adnexal mass in the postmenopausal patient. Clin Obstet Gynecol 2015; 58:53-65. PubMed
  • Prabhakar HB, Kraeft JJ, Schorge JO, Scott JA, Lee SI. FDG PET-CT of gynecologic cancers: pearls and pitfalls. Abdom Imaging 2015. PubMed
  • Wu RI, Schorge JO, Dal Cin P, Cin PD, Young RH, Oliva E. Mç«Żllerian adenosarcoma of the uterus with low-grade sarcomatous overgrowth characterized by prominent hydropic change resulting in mimicry of a smooth muscle tumor. Int J Gynecol Pathol 2014; 33:573-80. PubMed
  • Schorge JO, Clark RM, Lee SI, Penson RT. Primary debulking surgery for advanced ovarian cancer: Are you a believer or a dissenter? Gynecol Oncol 2014. PubMed
  • Rauh-Hain JA, Hinchcliff EM, Oduyebo T, Worley MJ, Andrade CA, Schorge JO, George S, Muto MG, Del Carmen MG. Clinical outcomes of women with recurrent or persistent uterine leiomyosarcoma. Int J Gynecol Cancer 2014; 24:1434-40. PubMed
  • Vargas R, Rauh-Hain JA, Clemmer J, Clark RM, Goodman A, Growdon WB, Schorge JO, Del Carmen MG, Horowitz NS, Boruta DM. Tumor size, depth of invasion, and histologic grade as prognostic factors of lymph node involvement in endometrial cancer: A SEER analysis. Gynecol Oncol 2014; 133:216-20. PubMed
  • Worley MJ, Guseh SH, Rauh-Hain JA, Esselen KM, Muto MG, Feltmate CM, Berkowitz RS, Del Carmen MG, Schorge JO, Horowitz NS. What is the optimal treatment for obese patients with advanced ovarian carcinoma? Am J Obstet Gynecol 2014. PubMed
  • Foley OW, Rauh-Hain JA, Clark RM, Goodman A, Growdon WB, Boruta DM, Schorge JO, Del Carmen MG. Intraoperative Radiation Therapy in the Management of Gynecologic Malignancies. Am J Clin Oncol 2014. PubMed
  • Guseh SH, Rauh-Hain JA, Tambouret RH, Davis M, Clark RM, Boruta DM, Goodman A, Growdon WB, Schorge JO, del Carmen MG. Transitional cell carcinoma of the ovary: a case-control study. Gynecol Oncol 2014; 132:649-53. PubMed
  • Davis M, Rauh-Hain JA, Andrade C, Boruta DM, Schorge JO, Horowitz NS, May T, del Carmen MG. Comparison of clinical outcomes of patients with clear cell and endometrioid ovarian cancer associated with endometriosis to papillary serous carcinoma of the ovary. Gynecol Oncol 2014; 132:760-6. PubMed
  • Rauh-Hain JA, Vargas RJ, Clemmer J, Clark RM, Bradford LS, Growdon WB, Goodman A, Boruta DM, Schorge JO, Del Carmen MG. Mucinous Adenocarcinoma of the Endometrium Compared With Endometrioid Endometrial Cancer: A SEER Analysis. Am J Clin Oncol 2014. PubMed
  • Rauh-Hain JA, Clemmer J, Clark RM, Bradford LS, Growdon WB, Goodman A, Boruta DM, Schorge JO, del Carmen MG. Racial disparities and changes in clinical characteristics and survival for vulvar cancer over time. Am J Obstet Gynecol 2013; 209:468.e1-468.e10. PubMed
  • Rauh-Hain JA, Davis M, Clemmer J, Clark RM, Growdon WB, Goodman AK, Boruta DM, Schorge JO, del Carmen MG. Prognostic determinants in patients with uterine and ovarian clear cell carcinoma: a SEER analysis. Gynecol Oncol 2013; 131:404-9. PubMed
  • Rauh-Hain JA, Clemmer JT, Bradford LS, Clark RM, Growdon WB, Goodman A, Boruta DM, Schorge JO, del Carmen MG. Racial disparities in cervical cancer survival over time. Cancer 2013; 119:3644-52. PubMed
  • Rauh-Hain JA, Diver EJ, Clemmer JT, Bradford LS, Clark RM, Growdon WB, Goodman AK, Boruta DM, Schorge JO, del Carmen MG. Carcinosarcoma of the ovary compared to papillary serous ovarian carcinoma: a SEER analysis. Gynecol Oncol 2013; 131:46-51. PubMed
  • Rauh-Hain JA, Guseh SH, Esselen KM, Growdon WB, Schorge JO, Horowitz NS, Krasner CN, del Carmen MG, Birrer MJ, Dizon DS. Patterns of recurrence in patients treated with bevacizumab in the primary treatment of advanced epithelial ovarian cancer. Int J Gynecol Cancer 2013; 23:1219-25. PubMed
  • Clark RM, Growdon WB, Wiechert A, Boruta D, Del Carmen M, Goodman AK, Bradford L, Rauh-Hain A, Schorge JO. Patient, treatment and discharge factors associated with hospital readmission within 30 days after surgical cytoreduction for epithelial ovarian carcinoma. Gynecol Oncol 2013; 130:407-10. PubMed
  • Schorge JO. Nonsurgical treatment of endometrial hyperplasia: is the road less traveled the one we should be taking more? Obstet Gynecol 2013; 121:1155-7. PubMed
  • Diver E, O'Connor O, Garrett L, Boruta D, Goodman A, Del Carmen M, Schorge J, Mueller P, Growdon W. Modest benefit of total parenteral nutrition and chemotherapy after venting gastrostomy tube placement. Gynecol Oncol 2013; 129:332-5. PubMed
  • Rauh-Hain JA, Nitschmann CC, Worley MJ, Bradford LS, Berkowitz RS, Schorge JO, Campos SM, Del Carmen MG, Horowitz NS. Platinum resistance after neoadjuvant chemotherapy compared to primary surgery in patients with advanced epithelial ovarian carcinoma. Gynecol Oncol 2013; 129:63-8. PubMed
  • Schorge JO, Rauh-Hain JA. Atypical glandular cells. Clin Obstet Gynecol 2013; 56:35-43. PubMed
  • Schorge JO. Controversies in cervical cancer screening. Clin Obstet Gynecol 2013; 56:1-2. PubMed
  • Garrett LA, Harmon DC, Schorge JO. Embryonal rhabdomyosarcoma of the uterine corpus. J Clin Oncol 2013; 31:e48-50. PubMed
  • Del Carmen MG, Birrer M, Schorge JO. Uterine papillary serous cancer: A review of the literature. Gynecol Oncol 2012; 127:651-61. PubMed
  • McCann CK, Growdon WB, Munro EG, Del Carmen MG, Boruta DM, Schorge JO, Goodman A. Prognostic Significance of Splenectomy as Part of Initial Cytoreductive Surgery in Ovarian Cancer. Ann Surg Oncol 2011. PubMed
  • Rauh-Hain JA, Growdon WB, Rodriguez N, Goodman AK, Boruta DM, Schorge JO, Horowitz NS, Del Carmen MG. Carcinosarcoma of the ovary: A case-control study. Gynecol Oncol 2011. PubMed
  • Bradford LS, Schorge JO. CA125 screening after risk-reducing salpingo-oophorectomy: are the titers too high, or is it all just too much? Menopause 2011; 18:123-4. PubMed
  • Lacour RA, Westin SN, Meyer LA, Wingo SN, Schorge JO, Brooks R, Mutch D, Molina A, Sutphen R, Barnes M, Elder J, Teoh D, Powell CB, Choubey V, Blank S, Macdonald HR, Brady MF, Urbauer DL, Bodurka D, Gershenson DM, Lu KH. Improved survival in non-Ashkenazi Jewish ovarian cancer patients with BRCA1 and BRCA2 gene mutations. Gynecol Oncol 2011. PubMed
  • Boruta DM, Growdon WB, Schorge JO. Single-incision laparoscopic staging for endometrial cancer. J Am Coll Surg 2010; 212:e1-5. PubMed
  • Curley MD, Garrett LA, Schorge JO, Foster R, Rueda BR. Evidence for cancer stem cells contributing to the pathogenesis of ovarian cancer. Front Biosci 2011; 16:368-92. PubMed
  • Rauh-Hain JA, Growdon WB, Schorge JO, Goodman AK, Boruta DM, McCann C, Horowitz NS, del Carmen MG. Prognostic determinants in patients with stage IIIC and IV uterine papillary serous carcinoma. Gynecol Oncol 2010; 119:299-304. PubMed
  • Whitehurst AW, Xie Y, Purinton SC, Cappell KM, Swanik JT, Larson B, Girard L, Schorge JO, White MA. Tumor antigen acrosin binding protein normalizes mitotic spindle function to promote cancer cell proliferation. Cancer Res 2010; 70:7652-61. PubMed
  • Schorge JO, Modesitt SC, Coleman RL, Cohn DE, Kauff ND, Duska LR, Herzog TJ. SGO White Paper on ovarian cancer: etiology, screening and surveillance. Gynecol Oncol 2010; 119:7-17. PubMed
  • Schorge JO, Wingo SN, Bhore R, Heffernan TP, Lea JS. Secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer. Int J Gynaecol Obstet 2010; 108:123-7. PubMed
  • Rueda BR, Tilly JL, Schorge JO. Surgical debulking before or after chemotherapy: stemming the tide on ovarian cancer recurrence. Onkologie 2010; 33:286-7. PubMed
  • Schorge JO, McCann C, Del Carmen MG. Surgical debulking of ovarian cancer: what difference does it make? Rev Obstet Gynecol 2011; 3:111-7. PubMed
  • Friel AM, Growdon WB, McCann CK, Olawaiye AB, Munro EG, Schorge JO, Castrillon DH, Broaddus RR, Rueda BR. Mouse models of uterine corpus tumors: clinical significance and utility. Front Biosci (Elite Ed) 2010; 2:882-905. PubMed
  • Wingo SN,Gallardo TD,Akbay EA,Liang MC,Contreras CM,Boren T,Shimamura T,Miller DS,Sharpless NE,Bardeesy N,Kwiatkowski DJ,Schorge JO,Wong KK,Castrillon DH. Somatic LKB1 mutations promote cervical cancer progression. PLoS ONE 2009; 4:e5137. PubMed
  • Akbay EA,Contreras CM,Perera SA,Sullivan JP,Broaddus RR,Schorge JO,Ashfaq R,Saboorian H,Wong KK,Castrillon DH. Differential roles of telomere attrition in type I and II endometrial carcinogenesis. Am J Pathol 2008; 173:536-44. PubMed
  • Miller DS,Blessing JA,Bodurka DC,Bonebrake AJ,Schorge JO. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol 2008; 110:65-70. PubMed
  • Bull Phelps SL, Schorge JO, Peyton MJ, Shigematsu H, Xiang LL, Miller DS, Lea JS. Implications of EGFR inhibition in ovarian cancer cell proliferation. Gynecol Oncol 2008; 109:411-7. PubMed
  • Gagnon A, Kim JH, Schorge JO, Ye B, Liu B, Hasselblatt K, Welch WR, Bandera CA, Mok SC. Use of a combination of approaches to identify and validate relevant tumor-associated antigens and their corresponding autoantibodies in ovarian cancer patients. Clin Cancer Res 2008; 14:764-71. PubMed
  • Bull-Phelps SL, Garner EI, Walsh CS, Gehrig PA, Miller DS, Schorge JO. Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix. Gynecol Oncol 2007; 107:316-9. PubMed
  • Oh JH,Nandi A,Gurnani P,Knowles L,Schorge J,Rosenblatt KP,Gao JX. Proteomic biomarker identification for diagnosis of early relapse in ovarian cancer. J Bioinform Comput Biol 2007; 4:1159-79. PubMed
  • Makarla PB,Saboorian MH,Ashfaq R,Toyooka KO,Toyooka S,Minna JD,Gazdar AF,Schorge JO. Promoter hypermethylation profile of ovarian epithelial neoplasms. Clin Cancer Res 2005; 11:5365-9. PubMed
  • Schorge JO, Drake RD, Lee H, Skates SJ, Rajanbabu R, Miller DS, Kim JH, Cramer DW, Berkowitz RS, Mok SC. Osteopontin as an adjunct to CA125 in detecting recurrent ovarian cancer. Clin Cancer Res 2004; 10:3474-8. PubMed
  • Ye B, Cramer DW, Skates SJ, Gygi SP, Pratomo V, Fu L, Horick NK, Licklider LJ, Schorge JO, Berkowitz RS, Mok SC. Haptoglobin-alpha subunit as potential serum biomarker in ovarian cancer: identification and characterization using proteomic profiling and mass spectrometry. Clin Cancer Res 2003; 9:2904-11. PubMed
  • Kim JH, Skates SJ, Uede T, Wong Kk KK, Schorge JO, Feltmate CM, Berkowitz RS, Cramer DW, Mok SC. Osteopontin as a potential diagnostic biomarker for ovarian cancer. JAMA 2002; 287:1671-9. PubMed
  • Garrett LA, Growdon WB, Goodman A, Boruta DM, Schorge JO, del Carmen MG. Endometriosis-associated ovarian malignancy: a retrospective analysis of presentation, treatment, and outcome. J Reprod Med 2014; 58:469-76. PubMed
  • Rauh-Hain JA, Shoni M, Schorge JO, Goodman A, Horowitz NS, del Carmen MG. Prognostic determinants in patients with uterine and ovarian carcinosarcoma. J Reprod Med 2013; 58:297-304. PubMed
  • Owusu-Darko S, Rauh-Hain JA, Horowitz NS, Goodman A, Schorge JO, Del Carmen MG. Comparison of outcomes in patients with early-stage mucinous endometrial cancer and those with endometrioid endometrial cancer, with and without adjuvant therapy. J Reprod Med 2015; 59:527-33. PubMed
  • Rauh-Hain JA, Goodman A, Boruta DM, Schorge JO, Horowitz NS, del Carmen MG. Endometrial stromal sarcoma: a clinicopathologic study of 29 patients. J Reprod Med 2015; 59:547-52. PubMed
Hide