Gary L Goldberg

Montefiore Medical Center, New York, New York, United States

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Publications (193)805.38 Total impact

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    ABSTRACT: To determine the physical activity (PA) behavior, needs and preferences for underserved, ethnically diverse women with a history of endometrial cancer (EC). Women with a history of EC (41 non-Hispanic black, 40 non-Hispanic white, and 18 Hispanic) completed a needs assessment during their regular follow-up appointments at Montefiore Medical Center in Bronx, NY, USA. An 8-week pilot PA intervention based on the results of the needs assessment was conducted with 5 EC survivors. Mean body mass index (BMI) among the 99 respondents was 34.1±7.6 kg/m², and 66% did not exercise regularly. Self-described weight status was significantly lower than actual BMI category (p<0.001). Of the 86% who were interested in joining an exercise program, 95% were willing to attend at least once weekly. The primary motivations were improving health, losing weight, and feeling better physically. Despite the high interest in participation, volunteer rate was very low (8%). However, adherence to the 8-week pilot PA intervention was high (83%), and there were no adverse events. Body weight decreased in all pilot participants. These data show that ethnically diverse EC survivors have a great need for, and are highly interested in, PA interventions. However, greater care needs to be taken to assess and identify barriers to increase participation in such programs.
    Journal of Gynecologic Oncology 04/2015; 26(2):141-7. DOI:10.3802/jgo.2015.26.2.141 · 1.60 Impact Factor
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    ABSTRACT: Background To date there have been no comprehensive, comparative assessments of the environmental impact of surgical modalities. Our study seeks to quantify and compare the total greenhouse gas emissions, or 'carbon footprint', attributable to three surgical modalities.MethodsA review of 150 staging procedures, employing laparotomy (LAP), conventional laparoscopy (LSC) or robotically-assisted laparoscopy (RA-LSC), was performed. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg CO2e) release into the environment. The carbon footprint is the sum of the waste production and energy consumption during each surgery (kg CO2e).ResultsThe total carbon footprint of a RA-LSC procedure is 40.3 kg CO2e/patient (p < 0.01). This represents a 38% increase over that of LSC (29.2 kg CO2e/patient; p < 0.01) and a 77% increase over LAP (22.7 kg CO2e/patient; p < 0.01).Conclusions Our results provide clinicians, administrators and policy-makers with knowledge of the environmental impact of their decisions to facilitate adoption of sustainable practices. Copyright © 2015 John Wiley & Sons, Ltd.
    International Journal of Medical Robotics and Computer Assisted Surgery 02/2015; DOI:10.1002/rcs.1640 · 1.53 Impact Factor
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    ABSTRACT: To evaluate the performance of simultaneous endometrial aspiration at the time of sonohysterography for screening postmenopausal women at risk for endometrial cancer. A retrospective cohort study of women older than 50 years who underwent saline-infusion sonohysterography for the evaluation of their endometrium. On completion of imaging, the remaining intracavitary saline and endometrial tissue were aspirated through the saline-infusion sonohysterography catheter and submitted for pathologic evaluation. Based on the clinical, pathologic, and ultrasonographic results, the patients underwent surgical treatment with hysteroscopy, hysterectomy, or clinical observation. Follow-up results and outcomes were collected using electronic medical records. Sensitivity, specificity, and predictive values of saline-infusion sonohysterography, endometrial aspiration, and combined approaches for endometrial aspiration and sonohysterography were assessed. Six hundred three patients underwent endometrial aspiration at the time of sonohysterography. Endometrial tissue was present in 567 (94.0%) and outcome data were available for 540 (89.5%). In 194 (35.9%) patients, final pathology was obtained by surgical intervention. The remaining 346 (64.1%) patients were monitored for at least 6 months. Thirty patients (5.6%) had cancer or endometrial hyperplasia. A sequential model, in which endometrial aspiration was done only for positive saline-infusion sonohysterography findings, yielded sensitivity of 86.7% (95% confidence interval [CI] 69-96%) and specificity of 100% (95% CI 99-100%) for detecting endometrial hyperplasia or cancer (area under the curve 0.93). Considering proliferative endometrium as abnormal endometrial aspiration reduced specificity to 88.3% (95% CI 85-91%, P<.01) without significant increase in sensitivity (100%, 95% CI 88-100%, P=.13). The high sensitivity and specificity of the sequential endometrial aspiration at the time of sonohysterography make this approach a useful and reliable screening algorithm for detecting endometrial cancer or hyperplasia in postmenopausal women at risk. Endometrial aspiration at the time of sonohysterography should be considered as an initial one-stop endometrial evaluation in this population. LEVEL OF EVIDENCE:: II.
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    ABSTRACT: Objective: To present a case of recurrent vulvar fibromatosis in an adolescent, discuss the specific difficulties of treating adolescents, and review the literature on available treatment. Methods: We present a case of recurrent vulvar fibromatosis in a 14-year-old girl, requiring several treatment modalities, including multiple surgeries, radiation therapy, and multiagent chemotherapy. We then discuss management strategies for these tumor types, and specifically examine how tumor location may impact their treatment. Results: Vulvar desmoids are extremely uncommon and they can be disfiguring and cause significant discomfort for women. Initial management of these tumors is surgical excision, yet failed surgery is often followed by other treatment modalities, including radiation, tyrosine kinase inhibitors, nonsteroidal anti-inflammatory drugs, hormonal therapy, and chemotherapy. This case clearly highlights the difficulties in managing these rare tumors, particularly in the adolescent population. Conclusions: Desmoid tumors are nonmalignant, locally aggressive neoplasms most common in the 15 to 60 years age group. They are associated with high estrogen states, prior surgical trauma, and Gardner syndrome. Most commonly, desmoid tumors present in the abdominal wall, shoulder, neck, and chest, but can occur anywhere in the body. Given their rarity and lack of definitive therapy, vulvar desmoid tumors can be exceedingly difficult to treat, and are best managed with an interdisciplinary approach.
    Journal of Pediatric Hematology/Oncology 09/2014; 37(1). DOI:10.1097/MPH.0000000000000261 · 0.96 Impact Factor
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    ABSTRACT: To determine the efficacy of image-guided drainage versus antibiotic-only treatment of pelvic abscesses.
    Journal of Minimally Invasive Gynecology 07/2014; DOI:10.1016/j.fertnstert.2014.06.025 · 1.58 Impact Factor
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    ABSTRACT: OBJECTIVE: Obesity is an established risk factor for development of endometrial cancer. We hypothesized that obesity might also be associated with an earlier age at endometrial cancer diagnosis, because mechanisms that drive the obesity-endometrial cancer association might also accelerate tumorigenesis. METHODS: A retrospective chart review was conducted of all cases of endometrial cancer diagnosed from 1999 to 2009 at a large medical center in New York City. The association of body mass index (BMI) with age at endometrial cancer diagnosis, comorbidities, stage, grade, and radiation treatment was examined using analysis of variance and linear regression. Overall survival by BMI category was assessed using Kaplan-Meier method and the log-rank test. RESULTS: A total of 985 cases of endometrial cancer were identified. The mean age at endometrial cancer diagnosis was 67.1 years (+/- 11.9 standard deviation) in women with a normal BMI, whereas it was 56.3 years (+/- 10.3 standard deviation) in women with a BMI greater than 50. Age at diagnosis of endometrioid-type cancer decreased linearly with increasing BMI (y=67.89-1.86x, R-2=0.049, P<.001). This association persisted after multivariable adjustment (R-2=0.181, P=.02). A linear association between BMI and age of nonendometrioid cancers was not found (P=.12). There were no differences in overall survival by BMI category. CONCLUSIONS: Obesity is associated with earlier age at diagnosis of endometrioid-type endometrial cancers. Similar associations were not, however, observed with nonendometrioid cancers, consistent with different pathways of tumorigenesis.
    Obstetrics and Gynecology 07/2014; 124(2). DOI:10.1097/AOG.0000000000000381 · 4.37 Impact Factor
  • Gynecologic Oncology 06/2014; 133:123. DOI:10.1016/j.ygyno.2014.03.323 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:78-79. DOI:10.1016/j.ygyno.2014.03.212 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:41. DOI:10.1016/j.ygyno.2014.03.120 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:205. DOI:10.1016/j.ygyno.2014.03.545 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:114. DOI:10.1016/j.ygyno.2014.03.301 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:110-111. DOI:10.1016/j.ygyno.2014.03.294 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:127-128. DOI:10.1016/j.ygyno.2014.03.334 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:176. DOI:10.1016/j.ygyno.2014.03.464 · 3.69 Impact Factor
  • Gynecologic Oncology 06/2014; 133:74-75. DOI:10.1016/j.ygyno.2014.03.201 · 3.69 Impact Factor
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    ABSTRACT: Purpose To compare rigosertib versus cisplatin as an effective radiosensitizing agent for cervical malignancies. Methods and Materials Rigosertib and cisplatin were tested in cervical cancer cell lines, HeLa and C33A. A 24-hour incubation with rigosertib and cisplatin, before irradiation (2-8 Gy), was used for clonogenic survival assays. Cell cycle analysis (propidium iodide staining) and DNA damage (γ-H2AX expression) were evaluated by fluorescence-activated cell sorter cytometry. Rigosertib was also tested in vivo in tumor growth experiments on cervical cancer xenografts. Results Rigosertib was demonstrated to induce a G2/M block in cancer cells. Survival curve comparison revealed a dose modification factor, as index of radiosensitization effect, of 1.1-1.3 for cisplatin and 1.4-2.2 for rigosertib. With 6-Gy irradiation, an increase in DNA damage of 15%-25% was achieved in both HeLa and C33A cells with cisplatin pretreatment, and a 71-108% increase with rigosertib pretreatment. In vivo tumor growth studies demonstrated higher performance of rigosertib when compared with cisplatin, with 53% longer tumor growth delay. Conclusions Rigosertib was more effective than cisplatin when combined with radiation and caused minimal toxicity. These data support the need for clinical trials with rigosertib in combination therapy for patients with cervical carcinoma.
    International journal of radiation oncology, biology, physics 04/2014; 88(5). DOI:10.1016/j.ijrobp.2013.12.051 · 4.18 Impact Factor
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    ABSTRACT: The objective of this study was to determine how often an elevated cancer antigen (CA) 19-9 (≥ 37 U/mL) was present during the preoperative evaluation of women with a mature cystic teratoma (MCT). This was a retrospective, consecutive case series (N = 139) of histologically proven MCT treated at Montefiore Medical Center from 1997 to 2008. Data were analyzed for patient and tumor characteristics, tumor markers (CA 19-9, CA 125, and carcinoembryonic antigen [CEA]), preoperative imaging, and procedure. CA 19-9 was elevated in 37.4% of patients. Elevated CA 19-9 was not significantly associated with age, race, CA 125 (≥35 U/mL), CEA (≥5 ng/mL), MCT size, or the presence of bilateral MCTs. Of the patients, 59% were ≥40 years old. Age <40 years was associated with cystectomy rather than oophorectomy (P < .001), regardless of CA 19-9 (P = .09). Elevated preoperative CA 19-9 in patients with MCT was associated with increased preoperative computed tomography (P = .04).
    Reproductive sciences (Thousand Oaks, Calif.) 02/2014; 21(10). DOI:10.1177/1933719114525274 · 2.18 Impact Factor
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    ABSTRACT: The aim of this retrospective study was to investigate the association of palliative medicine consultation with inpatient hospital costs and ACE (aggressiveness of care at the end of life) scores in patients with gynecologic malignancies. Data were obtained from inpatient and outpatient medical records of 100 consecutive patients who died of primary gynecologic malignancies at a single institution. Timely consultation for palliative care was defined as exposure to inpatient consultation for 30 days or more before death. Metrics used to tabulate ACE scores included the following: admission to intensive care, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission less than 3 days before death. Hospital accounting records were used to calculate inpatient direct costs for the last 30 days of life. Statistical methods included Fisher exact and Student t testing, Mann-Whitney U testing, and Kaplan-Meier statistics. Of the total patient sample, 49% (n = 49) had a palliative care consultation, and 18% (n = 18) had timely consultation. The median composite ACE score was significantly lower for patients with timely palliative medicine consultation (≥30 days before death) than for patients with untimely/no consultation: 0 (range, 0–3) versus 2 (range, 0–6), P = 0.025. Median inpatient direct costs were lower for the last 30 days of life among patients with timely consultation than those with untimely consultation: $0 (range, $0–$28,019) versus $7729 ($0–$52,720), P = 0.01. These data show that timely palliative medicine consultation reduced inpatient direct hospital costs and lowered ACE scores. Prospective studies are needed to validate these findings.
    Obstetrical and Gynecological Survey 01/2014; 69(7):400-402. DOI:10.1097/OGX.0000000000000080 · 2.36 Impact Factor
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    ABSTRACT: Myxofibrosarcoma or malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma. However, primary pelvic and retroperitoneal myxoid is an extremely rare tumor. We report a case of a 49-year-old woman diagnosed with primary MFH originating from the left gluteal muscle and presenting with a large pelvic mass. A 49-year-old woman G0 presented with a 3-year history of progressive left leg sciatica pain, left lower extremity edema, and a pelvic mass consistent with low-grade malignant fibrous histiocytoma upon surgical resection. Despite adjuvant radiotherapy (RT), she developed recurrence underwent within 7 months. She underwent repeat surgical resection with histopathology showing a MFH with high-grade features. We describe this case and review the literature of MFH. MFH of the pelvis and retroperitoneum is extremely rare. It has a high mortality rate and short overall survival. The tumor is characterized by local invasion, while lymph node or vascular metastases are uncommon. Complete tumor resection is the best primary treatment and is usually followed by adjuvant RT or chemotherapy. These patients must have close observation for local recurrence.
    Comparative Clinical Pathology 01/2014; 23(2). DOI:10.1007/s00580-012-1627-y
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    ABSTRACT: Objective: Impaired glucose tolerance and diabetes are risk factors for the development of uterine cancer. Although greater progression free survival among diabetic patients with ovarian and breast cancer using metformin have been reported, no studies have assessed the association of metformin use with survival in women with endometrial cancer (EC). Methods: We conducted a single-institution retrospective cohort study of all patients treated for uterine cancer from January 1999 through December 2009. Demographic, medical, social, and survival data were abstracted from medical records and the national death registry. Overall survival (OS) was estimated using Kaplan-Meier methods. Cox models were utilized for multivariate analysis. All statistical tests were two-sided. Results: Of 985 patients, 114 (12%) had diabetes and were treated with metformin, 136 (14%) were diabetic but did not use metformin, and 735 (74%) had not been diagnosed with diabetes. Greater OS was observed in diabetics with non-endometrioid EC who used metformin than in diabetic cases not using metformin and non-endometrioid EC cases without diabetes (log rank test (p=0.02)). This association remained significant (hazard ratio=0.54, 95% CI: 0.30-0.97, p<0.04) after adjusting for age, clinical stage, grade, chemotherapy treatment, radiation treatment and presence of hyperlipidemia in multivariate analysis. No association between metformin use and OS in diabetics with endometrioid histology was observed. Conclusion: Diabetic EC patients with non-endometrioid tumors who used metformin had lower risk of death than women with EC who did not use metformin. These data suggest that metformin might be useful as adjuvant therapy for non-endometrioid EC.
    Gynecologic Oncology 11/2013; DOI:10.1016/j.ygyno.2013.10.026 · 3.69 Impact Factor

Publication Stats

2k Citations
805.38 Total Impact Points

Institutions

  • 2001–2015
    • Montefiore Medical Center
      • • Department of Obstetrics and Gynecology (Women's Health)
      • • Department of Oncology
      • • Albert Einstein College of Medicine
      New York, New York, United States
  • 1989–2015
    • Albert Einstein College of Medicine
      • • Department of Obstetrics & Gynecology & Women's Health
      • • Department of Radiology
      • • Department of Medicine
      New York, New York, United States
  • 1992–2013
    • Albert Einstein Medical Center
      Philadelphia, Pennsylvania, United States
    • City University of New York - Bronx Community College
      New York, New York, United States
  • 2006
    • Shahid Beheshti University of Medical Sciences
      Teheran, Tehrān, Iran
  • 2003
    • Cornell University
      Итак, New York, United States
  • 2002
    • Women’s Health Institute of Illinois
      Oak Lawn, Illinois, United States