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MRI-Guided Focused Ultrasound Surgery for Uterine Fibroids
Patients undergoing the procedure had sustained symptom improvement for 1 year.
Given the morbidity associated with hysterectomy, less-invasive options for treating symptomatic uterine fibroids are appealing. In this manufacturer-sponsored, prospective, multicenter trial, investigators evaluated the efficacy of magnetic resonance imaging (MRI)-guided focused ultrasound for the treatment of leiomyomas in 160 substantially symptomatic women (mean age, 46). The treatment goal was to induce a large area of nonperfusion in the leiomyoma. Patients were treated according to original or modified treatment guidelines; modified guidelines allowed for a second treatment, treatment of a greater fibroid volume, and longer treatment time. Symptom severity scores (SSSs) were calculated at 3, 6, and 12 months, based on completed uterine fibroid symptom and quality-of-life questionnaires.
About one third of the women in each group had sought alternative treatment at 1 year or were lost to follow-up (and were assumed to have experienced treatment failure). Overall, mean SSSs improved significantly at 3, 6, and 12 months, with maximum improvement at 3 months. At 12 months, mean SSSs were similar in the two treatment groups.
Comment: These findings suggest that improvement in symptoms after MRI-guided focused ultrasound treatment of fibroids can be sustained for 1 year. However, the number of women followed for 1 year was small, and patients were not randomized to
receive alternative procedures, such as hysterectomy or uterine artery embolization. Also, whether expertise with the technology influences outcome is unclear. Randomized studies, ideally with cost analysis, will help determine which treatment options have the best risk/benefit profiles for a given patient; until then, it is too soon to refer patients routinely for this new intervention.
Published in Journal Watch Women's Health August 9, 2007
Citation(s):
Fennessy FM et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery — Results of different treatment protocols. Radiology 2007 Jun; 243:885-93.
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