Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: Long-term results
Introduction
Treatment options for symptomatic uterine fibroids have broadened over the last two decades. Moreover, many women are now seeking uterus-sparing alternatives that are less invasive than traditional surgical treatments [1]. Uterine artery embolization (UAE) has emerged as the leading minimally invasive treatment for fibroids after the seminal publication by Ravina et al. in 1995 [2]. Magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU), a non-invasive treatment involving focused ultrasound energy to ablate fibroid tissue, was approved by the U.S. Food and Drug Administration (FDA) and modified in 2004. Both UAE and MR-g HIFU have been recognized as safe and efficacious treatments in symptomatic fibroid disease, although so far no direct comparison has been published [3], [4], [5], [6], [7], [8], [9], [10], [11], [12].
The aim of the present study was to evaluate and compare the long-term re-intervention rate and changes in symptom severity (SS) and total health-related quality of life (Total HRQoL) scores among patients undergoing UAE or MR-g HIFU for symptomatic uterine fibroids, using for this comparison the validated uterine fibroid symptom severity and quality of life (UFS-QoL) questionnaire [13], [14].
Section snippets
Study participants and enrollment
This study was a retrospective analysis of a prospectively collected database. The institutional review board approved the entire study and each patient gave written informed consent. All women included in this study had symptomatic fibroids, were premenopausal, completed the UFS-QoL questionnaire at baseline and follow-up interview and underwent magnetic-resonance imaging (MRI) before therapy. All included women underwent UAE or MR-g HIFU between 2002 and 2009 at our institution and were
Results
In the period of 2002 and 2009 a total of 366 women with symptomatic fibroids and baseline UFS-QoL questionnaire either underwent UAE or MR-g HIFU therapy at our institution. Patients included in this study based on the exclusion criteria which are given in the flow-chart diagram (Fig. 1). Baseline demographic data of the study population are given in Table 4. Fibroid related SS and Total HRQoL were reevaluated by the UFS-QoL questionnaire after a median of 61.9 months after UAE and 60.7 months
Discussion
In this study, we compared the long-term outcome after UAE and MR-g HIFU in women with symptomatic fibroids.
With a re-intervention rate of 12.2% in the UAE group, our results are partly within the range of long-term outcomes reported for UAE in the literature like by Katsumori et al. with a cumulative rate of symptom control of 89.5% or Scheurig et al. with a failure rate of 17% and partly better than data given in the literature like Spies et al. with a failure rate of 20% until 5 years after
References (18)
- et al.
Arterial embolisation to treat uterine myomata
Lancet
(1995) - et al.
MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes
Acad Radiol
(2011) - et al.
Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas
J Vasc Interv Radiol
(2008) - et al.
The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata
Obstet Gynecol
(2002) - et al.
Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids
Fertil Steril
(2006) - et al.
Quality-of-life assessment of fibroid treatment options and outcomes
Radiology
(2011) - et al.
Uterine artery embolization for fibroids: a review of current outcomes
Semin Reprod Med
(2010) - et al.
Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up
Ultrasound Obstet Gynecol
(2009) - et al.
Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial
Am J Obstet Gynecol
(2010)
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2021, European Journal of RadiologyCitation Excerpt :Five case reports were included. Only one study reported on a control group of women treated by UAE [22]. Seven of the fourteen studies had reproductive outcomes as their primary outcome.
Uterine Artery Embolization Compared with High-intensity Focused Ultrasound Ablation for the Treatment of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis
2021, Journal of Minimally Invasive GynecologyCitation Excerpt :Four studies [15–17,20] reported UFS-QoL scores at baseline and after treatment. The reintervention rate, incidence of adverse events, and pregnancy rate were reported in 5 studies [15–18,20], 2 studies [17,19], and 2 studies [15,16], respectively. The median age ranged between 41.2 years and 46.0 years in the UAE group and between 36.1 years and 44.0 years in the HIFU ablation group.
Uterine Myomas: Extravascular Treatment
2021, Seminars in Ultrasound, CT and MRICitation Excerpt :Some series with limited follow-up length described a few cases who underwent further HIFU treatment, UAE or surgery for enlarging residual tumor, unsatisfactory results, or persistent symptoms.47,50,72,78 Some authors reported a high rate of re-interventions (47% at 15 months,74 58.64% at 5 years,79 66.7% at 60.7 months80). Gorny et al81 described the cumulative incidence of additional treatments after MR-guided HIFU ablation of 19% and 23% at 36- and 48-month follow-up, respectively; older patients and hypointense fibroids were associated with fewer additional treatments needed.