Abstract
Purpose
To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance–guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids.
Methods
Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared.
Results
The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061).
Conclusion
UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.
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References
Buttram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36:433–445
Vollenhoven BJ, Lawrence AS, Healy DL (1990) Uterine fibroids: a clinical review. Br J Obstet Gynaecol 97:285–298
Stewart EA (2001) Uterine fibroids. Lancet 357(9252):293–298
Fennessy FM, Kong CY, Tempany CM et al (2011) Quality-of-life assessment of fibroid treatment options and outcomes. Radiology 259:785–792
Scheurig-Muenkler C, Wagner M, Franiel T et al (2010) Effect of uterine artery embolization on uterine and leiomyoma perfusion: evidence of transient myometrial ischemia on magnetic resonance imaging. J Vasc Interv Radiol 21:1347–1353
Vo NJ, Andrews RT (2008) Uterine artery embolization: a safe and effective, minimally invasive, uterine-sparing treatment option for symptomatic fibroids. Semin Interv Radiol 25:252–260
Ravina JH, Herbreteau D, Ciraru-Vigneron N et al (1995) Arterial embolisation to treat uterine myomata. Lancet 346(8976):671–672
Spies JB, Ascher SA, Roth AR et al (2001) Uterine artery embolization for leiomyomata. Obstet Gynecol 98:29–34
Spies JB, Myers ER, Worthington-Kirsch R et al (2005) The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol 106:1309–1318
Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272
Hesley GK, Felmlee JP, Gebhart JB et al (2006) Noninvasive treatment of uterine fibroids: early Mayo Clinic experience with magnetic resonance imaging-guided focused ultrasound. Mayo Clin Proc 81:936–942
Stewart EA, Rabinovici J, Tempany CM et al (2006) Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 85:22–29
Stewart EA, Gostout B, Rabinovici J et al (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110(2 Pt 1):279–287
Gorny KR, Woodrum DA, Brown DL et al (2011) Magnetic resonance–guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol 22:857–864
Hindley J, Gedroyc WM, Regan L et al (2004) MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol 183:1713–1719
Fennessy FM, Tempany CM, McDannold NJ et al (2007) Uterine leiomyomas: MR imaging–guided focused ultrasound surgery—results of different treatment protocols. Radiology 243:885–893
Scheurig C, Gauruder-Burmester A, Kluner C et al (2006) Uterine artery embolization for symptomatic fibroids: short-term versus mid-term changes in disease-specific symptoms, quality of life and magnetic resonance imaging results. Hum Reprod 21:3270–3277
Spies JB, Allison S, Flick P et al (2004) Polyvinyl alcohol particles and trisacryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol 15:793–800
Worthington-Kirsch R, Spies JB, Myers ER et al (2005) The fibroid registry for outcomes data (FIBROID) for uterine embolization: short-term outcomes. Obstet Gynecol 106:52–59
Chung AH, Hynynen K, Colucci V et al (1996) Optimization of spoiled gradient-echo phase imaging for in vivo localization of a focused ultrasound beam. Magn Reson Med 36:745–752
Funaki K, Fukunishi H, Sawada K (2009) Clinical outcomes of magnetic resonance–guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 34:584–589
Zhou YF (2011) High intensity focused ultrasound in clinical tumor ablation. World J Clin Oncol 2:8–27
Hengst SA, Ehrenstein T, Herzog H et al (2004) Magnetic resonance tomography guided focussed ultrasound surgery (MR-g HIFU) in tumor therapy—a new noninvasive therapy option. Radiologe 44:339–346
Spies JB, Coyne K, Guaou Guaou N (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99:290–300
Harding G, Coyne KS, Thompson CL et al (2008) The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes 12:99
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Froeling, V., Meckelburg, K., Scheurig-Muenkler, C. et al. Midterm Results after Uterine Artery Embolization Versus MR-Guided High-Intensity Focused Ultrasound Treatment for Symptomatic Uterine Fibroids. Cardiovasc Intervent Radiol 36, 1508–1513 (2013). https://doi.org/10.1007/s00270-013-0582-6
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DOI: https://doi.org/10.1007/s00270-013-0582-6