Lawrence E Ginsberg

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (106)413.63 Total impact

  • 02/2015; 76(S 01). DOI:10.1055/s-0035-1546702
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    ABSTRACT: BACKGROUND The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer. METHODS Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated. RESULTS The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01). CONCLUSIONS Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.
    Cancer 01/2015; DOI:10.1002/cncr.29241 · 5.20 Impact Factor
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    ABSTRACT: Background: Primary extradural meningiomas (PEMs) are rare, particularly those involving the paraspinal cervical area, so little is known about them. We identified a new case and compare it with 10 previous cases, address the diagnostic challenges, and highlight the clinical and pathologic characteristics.Methods: Case report and literature review of cases reported since 1976.Results: A 59-year-old man presented with right neck stiffness and discomfort over several months, which is consistent with other cases. CT scan and MRI revealed a paraspinal cervical mass. FNA and core biopsy revealed spindle cells with whorling consistent with meningioma. The patient underwent complete en bloc resection of the tumor. The PEM was histologically benign.Conclusions: Cervical PEMs should be considered in the differential diagnosis of a deep neck mass. These tumors are typically benign and are surgically resected. Head Neck, 2014
    Head & Neck 09/2014; DOI:10.1002/hed.23874 · 2.83 Impact Factor
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    ABSTRACT: Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.
    08/2014; 75(1):e84-8. DOI:10.1055/s-0034-1368149
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    ABSTRACT: Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than do HPV-negative oropharyngeal cancers. However, among patients with HPV-positive oropharyngeal carcinomas, those with a significant smoking history have a much worse prognosis. Recently, imaging characteristics of oropharyngeal cancers were identified as markers of poor prognosis. The purpose of this study was to determine whether nodal imaging characteristics differ between smokers and never/light smokers with HPV-positive oropharyngeal cancer.
    Journal of Computer Assisted Tomography 06/2014; DOI:10.1097/RCT.0000000000000100 · 1.60 Impact Factor
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    ABSTRACT: Tumors that recur following orbital exenteration may not be evident on clinical examination, highlighting the need for imaging surveillance. The goal of this study was to report the imaging characteristics of recurrent tumors following orbital exenteration and free flap reconstruction.
    Ophthalmic Plastic and Reconstructive Surgery 05/2014; DOI:10.1097/IOP.0000000000000100 · 0.91 Impact Factor
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    ABSTRACT: The goal of this study was to describe computed tomographic findings in patients with clinically proven temporal bone (TB) osteoradionecrosis (ORN) (TB-ORN).
    Journal of Computer Assisted Tomography 05/2014; DOI:10.1097/RCT.0000000000000096 · 1.60 Impact Factor
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    ABSTRACT: To facilitate detection of tumor recurrence, the authors reviewed the MRI characteristics of myocutaneous and fasciocutaneous free flaps following orbital exenteration for treatment of orbital or maxillofacial tumors. The authors retrospectively reviewed the MRI characteristics, including T1 and T2 signal intensity, and enhancement pattern of 28 such flaps. The study included 17 myocutaneous flaps and 11 fasciocutaneous flaps placed in 28 patients. For 23 flaps, additional imaging was performed after baseline imaging (range, 2-65 months after surgery). On precontrast T1 imaging, 15 of 17 myocutaneous flaps demonstrated a striated appearance similar to that of native muscle. Twenty-six of the 28 flaps in the series were T2 hyperintense. On baseline imaging, 26 flaps showed linear (n = 5), patchy (n = 10), or homogeneous (n = 11) enhancement. No flaps demonstrated mass-like enhancement. Five fasciocutaneous and 5 myocutaneous flaps showed decreased enhancement on follow-up imaging, while 4 myocutaneous flaps showed increased enhancement. Fourteen patients received postoperative radiation, 4 of which demonstrated increased enhancement, which subsequently decreased in 3 flaps. Fourteen of 23 followed flaps became smaller over time. On MRI, both myocutaneous and fasciocutaneous flaps placed after orbital exenteration generally demonstrate persistent non-mass-like enhancement and T2 hyperintensity, and both types of flaps may become smaller over time. Head and neck radiologists, ophthalmologic and plastic surgeons, and oncologists should be aware of the range of imaging features of these flaps to avoid misinterpreting the postoperative appearance as tumor recurrence.
    Ophthalmic plastic and reconstructive surgery 04/2014; DOI:10.1097/IOP.0000000000000103 · 0.69 Impact Factor
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    ABSTRACT: Purpose/Objective(s):Primary brain and central nervous system (CNS) tumor incidence is approximately 19 per 100,000 individuals per year in the United States (US) compared with 7 per 100,000 individuals worldwide.The most common intra-axial tumor is gliomas, which account for 32% of all primary CNS tumors and 80% of all malignant tumors of the CNS.The most common diffuse glioma is grade IV astrocytoma (glioblastoma, GBM), which makes up 54% of diffuse glial tumors. GBM is also the most aggressive brain tumor with poor prognosis.GBM metastases outside the CNS are rare, so therapeutic experience with these types of tumors is limited.Materials/Methods:Herein, we present 3 GBM patients with extra-CNS metastasis.Results:One patient developed GBM metastasis in the lung and pleura 5 years after his GBM diagnosis had been confirmed. Another patient who underwent resection of the primary GBM developed disease that extended through the sphenoid to involve the orbit and skull and subsequently invaded the parotid gland and neck nodes 1 year after diagnosis. A third patient developed GBM metastasis in the skull and L5 vertebra 2 years after her primary brain tumor had been resected.Conclusions:The exact mechanism of GBM metastasis outside the central nervous system is not well understood but likely involves the invasion of structures such as bone, lymphatics, and vasculature, especially veins. Above-average survival time and repeated surgical intervention may place GBM patients at higher risk for these unusual metastases
    Journal of Clinical Oncology 02/2014; 32(22). DOI:10.1200/JCO.2013.48.7546 · 17.88 Impact Factor
  • Conference Paper: Perineural Spread
    Lawrence E. Ginsberg
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    ABSTRACT: LEARNING OBJECTIVES 1) Review the various cutaneous malignancies that may afflict the face and scalp, focusing on imaging appearance and staging evaluation. 2) Understand the clinical circumstances and imaging appearance and strategies related to perineural tumor spread in head and neck malignancies. 3) Understand the spectrum of upper aerodigestive tract malignancy attributable to minor salivary glands, including the anatomic distribution, imaging appearance including non-specificity, and patterns of spread, particularly by perineural mechanism.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: BACKGROUND AND PURPOSE:Imaging correlates of genetic expression have been found for prognostic and predictive biomarkers of some malignant diseases, including breast and brain tumors. This study tests the hypothesis that imaging findings correlate with relevant genomic biomarkers in oral cavity squamous cell carcinoma.MATERIALS AND METHODS:Surplus frozen tissue from 27 untreated patients with oral cavity squamous cell carcinoma who underwent preoperative CT imaging was analyzed for gene expression. A team of neuroradiologists blinded to the genomic analysis results reviewed an extensive list of CT findings. The imaging correlated with genomic expression for cyclin D1, angiogenesis-related genes (vascular endothelial growth factor receptors and ligands), which relate to enhancement on the basis of other tumor types; and epidermal growth factor receptor, which may relate to proliferation and mass effect.RESULTS:Expression of vascular endothelial growth factor receptors 1 and 2 correlated with the enhancement of the primary tumor (P = .018 and P = .025, respectively), whereas the epidermal growth factor receptor correlated with mass effect (P = .03). Other exploratory correlations included epidermal growth factor receptor to perineural invasion (P = .05), and certain vascular endothelial growth factor receptors and ligands to mass effect (P = .03) and increased (P = .01) or decreased (P = .02) primary tumor size.CONCLUSIONS:We report that CT imaging correlates with gene expression in untreated oral cavity squamous cell carcinoma. Enhancement of the primary tumor and degree of mass effect correlate with relevant genomic biomarkers, which are also potential drug targets. Eventually, treatment decisions may be aided by combining imaging findings into meaningful phenotypes that relate directly to genomic biomarkers.
    American Journal of Neuroradiology 06/2013; 34(9). DOI:10.3174/ajnr.A3635 · 3.17 Impact Factor
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    ABSTRACT: Purpose: To determine whether correlations exist between CT‐generated texture features and genetic biomarkers in oral cavity squamous cell carcinoma (OCSCC). Methods: We retrospectively analyzed 27 OCSCC patients with surplus frozen tissue and preoperative CT for genetic expression of vascular endothelial growth factor (VEGF) ligands A B, and C, VEGF receptors 1, 2, and 3, Cyclin D1 protein, and epidermal growth factor receptor (EGFR). Each tumor was segmented, blinded to the results of the gene expression analysis, on their preoperative CT and was modified into a 6‐bit grayscale image prior to texture feature extraction. Seven calculated texture features were computed based on intensity histograms (IHIST) and co‐occurrence matrices (COM). Pearson correlation coefficients (PC) were calculated between texture features and genetic expression. A sub‐group analysis (n = 17) was performed excluding patients that had a CT slice thickness greater than 1mm. Results: Correlations were found between IHIST‐kurtosis and VEGF‐receptor1 (PC = 0.42, p = 0.03) as well as between IHIST‐mean and COM‐correlation with VEGF‐receptor 1 (PC = 0.40, p = 0.04 and ‐ 0.39, p = 0.04, respectively). In the subset analysis with more controlled preoperative CT scans, the correlation between IHIST‐kurtosis and VEGF‐receptor1 remained (PC = 0.54, p = 0.03) while the correlations with VEGF‐receptor 1 did not. Additionally, IHIST‐entropy was found to correlate with VEGF ligand A (PC = −0.51, p = 0.04). This correlation is arguably the most useful as an established chemotherapy agent exists for VEGFA (bevacizumab). However, no correlations survived a Bonferroni correction for multiple hypothesis testing in the initial or subset analyses. Conclusion: This study provides some preliminary data indicating that CT‐based texture features may be correlated with genetic expression in OCSCC. In future studies, a larger sample size and more focused hypothesis of texture correlations with specific genetic targets should be implemented.
    Medical Physics 06/2013; 40(6):377. DOI:10.1118/1.4815172 · 3.01 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE:Human papillomavirus-positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.MATERIALS AND METHODS:A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ(2) test was used for the matched-pair analysis.RESULTS:By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).CONCLUSIONS:In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.
    American Journal of Neuroradiology 05/2013; 34(10). DOI:10.3174/ajnr.A3524 · 3.17 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE:Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity.MATERIALS AND METHODS:Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data.RESULTS: New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity.CONCLUSIONS:Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity.
    American Journal of Neuroradiology 03/2013; 34(8). DOI:10.3174/ajnr.A3461 · 3.17 Impact Factor
  • Komal Shah, Bita Esmaeli, Lawrence E Ginsberg
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    ABSTRACT: Perineural spread along the nasociliary branch of the ophthalmic nerve has not been previously described, to our knowledge. One case of cutaneous squamous carcinoma at the medial canthus and another of melanoma of the nasal ala, with nasociliary nerve perineural spread, are illustrated here. Whereas magnetic resonance imaging is preferred to search for perineural spread, computed tomography may also demonstrate perineural thickening and enhancement. Awareness of the computed tomography appearance of perineural spread will aid in avoiding misdiagnosis.
    Journal of computer assisted tomography 03/2013; 37(2):282-285. DOI:10.1097/RCT.0b013e31827cd39e · 1.38 Impact Factor
  • Vinodh A Kumar, Komal B Shah, Lawrence E Ginsberg
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    ABSTRACT: Our purpose was to present 3 cases of perineural tumor spread (PNS) to the oculomotor (CN III) nerve. To our knowledge, PNS to CN III has not been previously reported. In the course of advanced PNS, typically with involvement of the cavernous sinus, tumor may spread in a retrograde fashion to involve CN III in the interpeduncular fossa and can even invade the brainstem.
    Journal of computer assisted tomography 01/2013; 37(4):525-7. DOI:10.1097/RCT.0b013e31828f4ba8 · 1.38 Impact Factor
  • Jackson D Hamilton, Stephen Y Lai, Lawrence E Ginsberg
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    ABSTRACT: Radiation therapy can result in osteoradionecrosis (ORN) and mucosal ulceration predisposing to infection. Fourteen patients presenting with infectious sequelae related to mandibular ORN were retrospectively reviewed. In most patients, infection followed diagnosis of ORN; but in 4 patients, ORN was not diagnosed until after the time of infection and imaging. An early imaging finding of ORN was lingual cortical defects near the last molar. Pain followed by erythema, purulent drainage, and subperiosteal abscess by imaging were the most common signs of infection. In most patients, conservative management eventually failed and segmental mandibulectomies were required. Soft tissue infection with characteristic bone findings such as subperiosteal abscess and cortical bone erosions helps to distinguish infected ORN from recurrent tumor or sterile ORN. In patients previously treated with radiation who present with infection, pain or an avid PET scan with bone involvement, the mandible should be scrutinized.
    Journal of computer assisted tomography 11/2012; 36(6):725-31. DOI:10.1097/RCT.0b013e3182702f09 · 1.38 Impact Factor
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    ABSTRACT: This analysis was undertaken to assess the need for planned neck dissection in patients with a complete response (CR) of involved nodes after irradiation and to determine the benefit of a neck dissection in those with less than CR by tumor site. Our cohort included 880 patients with T1-4, N1-3M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received treatment between 1994 and 2004. Survival curves were calculated by the Kaplan-Meier Method, comparisons of rates with the log-rank test and prognostic factors by Cox's proportional hazard model. Nodal CR occurred in 377 (43%) patients, of whom 365 patients did not undergo nodal dissection. The 5-year actuarial regional control rate of patients with CR was 92%. Two hundred sixty-eight of the remaining patients (53%) underwent neck dissections. The 5-year actuarial regional control rate for patients without a CR was 84%. Those who had a neck dissection fared better with 5-year actuarial regional control rates of 90% and 76% for those operated and those not operated (p < 0.001). Variables associated with poorer regional control rates included higher T and N stage, non-oropharynx cancers, non-CR, both clinical and pathological. With 92% 5-year neck control rate without neck dissection after CR, there is little justification for systematic neck dissection. The addition of a neck dissection resulted in higher neck control after partial response though patients with viable tumor on pathology specimens had poorer outcomes. The identification of that subgroup that benefits from additional treatment remains a challenge.
    International journal of radiation oncology, biology, physics 03/2012; 82(3):e367-74. DOI:10.1016/j.ijrobp.2011.03.062 · 4.59 Impact Factor
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    ABSTRACT: The aim of this report was to describe the computed tomography features of injected carboxymethylcellulose and how it can be mistaken for tumor recurrence. Carboxymethylcellulose is a low-density injectable indicated for short-term vocal fold augmentation. When used in patients with head and neck cancer, differentiating this agent from a neoplastic recurrence can be difficult on imaging. The imaging findings of five patients who received carboxymethylcellulose augmentation are presented to illustrate a potential pitfall of image interpretation. When injectable carboxymethylcellulose is used in cancer patients, knowledge of the injection sites, material used, and procedural history can avoid misinterpretation of monitory imaging.
    The Laryngoscope 02/2012; 122(2):307-10. DOI:10.1002/lary.22414 · 2.03 Impact Factor
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    ABSTRACT: We report, for the first time, a primary oral presentation of a germ cell yolk sac tumor in a 4-year-old girl with Aicardi syndrome. The diagnosis, differential diagnosis, and histogenesis are discussed.
    Human pathology 01/2012; 43(6):939-42. DOI:10.1016/j.humpath.2011.09.015 · 2.81 Impact Factor

Publication Stats

2k Citations
413.63 Total Impact Points


  • 1995–2015
    • University of Texas MD Anderson Cancer Center
      • • Department of Radiology
      • • Division of Diagnostic Imaging
      • • Department of Plastic Surgery
      • • Endocrine Neoplasia and Hormonal Disorders
      Houston, Texas, United States
  • 1996
    • University of Houston
      Houston, Texas, United States