Brigham and Women’s Hospital, Department of Radiology Evaluation of the Efficacy of Uterine Artery Embolization for Focused Ultrasound Surgery Therapeutic Failures Alisa Suzuki, MD Brigham and Women’s Hospital, Department of Radiology
Basic Fibroid Treatment Algorithm asymptomatic symptomatic operation hormone therapy Watch carefully MRgFUS laparotomy laparoscopy hysteroscopy UAE hysterectomy TCR stable myomectomy progression T V Hysterectomy L Hysterectomy observation LAVHysterectomy L Myomectomy LA Myomectomy
We evaluate the effect of UAE in patients who are unsatisfied with FUS treatment.
New treatment option from radiology for SYMPTOMATIC FIBROIDS MR guided Focused Ultrasound Surgery = since 2001 MRgFUS = a new method of non-invasive thermal(heat) ablation for symptomatic fibroids. 73% to 91 % of the women who have been treated reported a significant improvement in their uterine fibroid symptoms. MRgFUS is an FDA-approved treatment for symptomatic uterine fibroids
UAE Procedure POST Procedure
UAE PRE 3 month POST
MRgFUS POST PRE
UAE and MRgFUS - similarities Less or non- invasive compared to conventional gynecological surgeries. = short hospital stay, short recovery = smaller incision, or no incision = No general anesthesia (intravenous conscious sedation) Similar or lower serious adverse event % = High patient satisfaction Performed by a radiologist
UAE vs. MRgFUS - differences procedure UAE MRgFUS Type Minimally invasive Non-invasive Hospital stay Overnight 10 min - 2hours Pain control Narcotics OTC pain killers Procedure time 20 min - 90 min 180 min Feasible numbers 1– innumerable/ one session 1 – 3/ Feasible size 0.5cm – 10 cm 4 – 10cm Access for the patient Most IR doctors will perform Not all hospital can provide
? 73 - 91% of women who have been treated with FUS reported a significant improvement in their uterine fibroid symptoms. 9 - 27 % of women did not report clinically satisfactory outcome. 10 patients underwent UAE subsequently at BWH. options : myomectomy, hysterectomy, UAE, re-FUS Patients were allowed to select their treatment.
Study design: FUS performed in BWH from March 2002 and June 2004. 7 patients were reviewed. Pre and post FUS and UAE uterine size. Pre and post FUS and UAE fibroid size. Clinical symptoms
Result 1 Size of Fibroid The mean volume of pre-FUS fibroid 279cc 12 month post-FUS fibroid 316cc, -13.0% post-UAE fibroid 163cc, -49% Significant decrease in size between post-FUS 12 month size and post-UAE fibroid size. (p=0.02)
Result 2 Size of Uterus The mean volume of pre-FUS uterus 617 cc Post-FUS 12 month uterus 682 cc, +10.0% post-UAE uterus was 475cc, - 31% Significant decrease in uterine size between pre-FUS and post UAE. (p=0.03) Significant decrease in size between 12 month post-FUS fibroid size and post-UAE fibroid size. (p=0.002)
Result 3 Clinical symptoms Clinical symptoms including heavy bleeding, bulk, and pelvic pressure were improved in all patients. (as reported by patient)
These two fibroids were targeted. @ FUS Nov-2003 These two fibroids were targeted. Post FUS Gd Image
Post FUS 6 & 13 months May- 04, 6 month follow up. Uterus size 12.1 x 11.7 x 9.8 cm, 721cc Jan -05, 13 month follow up. Uterus size 14.4 x 12.4 x 7.8 cm, 738cc
@ UAE, Post FUS 23 months Dec-05 UAE.
Post UAE 13 months, Post FUS 36 month Jan -05, Post FUS 13 month follow up. Uterus size 14.4 x 12.4 x 7.8 cm, 738cc Nov-06 Post FUS 36 m, post UAE 13 m follow up. Uterine size 11.4 x 9.6 x 8.4 cm, 487.2cc
UAE can be therapeutic after unsatisfactory outcomes of FUS. MRg FUS is a new, exciting technique which can ‘zap’ fibroids in 3 hours while the patient is sleeping on the MRI table. Patients who develop clinical failure after FUS treatment could subsequently receive full benefit from Uterine Artery Embolization. Now we can comfortably inform patients that an FUS treatment failure does not require subsequent highly invasive surgery procedure as a minimally invasive procedure (like UAE) may resolve the patient's symptoms.
There are many areas where our experience with FUS is limited. Due to the newness of FUS, there is limited long-term follow up data on patients.