SIR: MR guided ultrasound a viable treatment option for uterine fibroids

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For the non-invasive treatment of benign uterine fibroids, magnetic resonance-guided focused ultrasound (MRgFUS) can be an effective therapy,  said Gina K. Hesley, MD, and colleagues from the Mayo Clinic in Rochester, Minn. at the 35th Society of Interventional Radiology (SIR) Annual Scientific Meeting in Tampa, Fla.

Since MRgFUS was cleared by the FDA in October, Hesley and her team of researchers have assessed the treatment outcomes of the outpatient procedure--which uses high-energy ultrasound waves to generate heat at a specific point to destroy uterine fibroid tissue and relieve symptoms-- in patients treated at the Mayo Clinic. They found that MRgFUS delivered lasting symptom relief in 97 percent of patients after a follow up period of twelve months and was helpful in avoiding myomectomy or hysterectomy,

The researchers followed 125 patients who were scheduled for MRgFUS at the Mayo Clinic between March 2005 and September 2008. During the three-year study, six patients were eliminated from the population due to treatment-related discomfort or pain causing these women to not complete the therapy. The remaining 119 patients were contacted after a follow-up period of 12 months post-treatment by way of telephone interviews to determine symptomatic relief and to assess additional procedures for fibroid-related symptoms.

The researchers were unable to contact 15 patients at follow-up, and four patients had their fibroids removed during surgeries performed for reasons unrelated to fibroid symptoms. Of the remaining 100 patients, eight had received additional treatments for their symptoms (6 hysterectomies and 2 myomectomies). A total of 89 patients were reached by telephone at the 12-month mark and symptomatic relief was self-reported by these patients on a percentage scale; 0-10 percent, insignificant; 11-40 percent, moderate; 41-70 percent, considerable; and 71-100 percent, excellent symptomatic relief.

Of the 89 patients, 69 indicated they received the following relief from symptoms: excellent (74 percent), considerable (16 percent), moderate (9 percent) and insignificant (1 percent), wrote the authors.  Three patients reported no percentage of improvement in their symptoms.

Hesley also said that the reported rate of additional treatments needed post-MRgFUS (8 percent) is within values reported for myomectomy and uterine fibroid embolization.

With 90 percent of patients rating their improvement as either considerable or excellent, Hesley said, "MRgFUS is newer than another interventional radiology fibroid treatment—uterine fibroid embolization or UFE—a widely available treatment that blocks blood flow to fibroid tumors. Our results with effectiveness of MRgFUS technology are promising and comparable with that of UFE, but its longer-term effectiveness needs continued study.”

Two and three-year results of symptom relief will be further studied by the Mayo researchers and the results reported for myomectomy and uterine artery embolization will be compared to the current finding, noted the authors.  In addition, the efficacy of MRgFUS in treating other uterine conditions, such as adenomyosis, will be investigated.

“Today, women have interventional radiology options that do not involve the use of a scalpel incision,” said Hesley. “Women should ask for a consult with an interventional radiologist who can determine from MR imaging whether they are candidates for either procedure.”