Clinical predictors of successful magnetic resonance-guided focused ultrasound (MRgFUS) for uterine leiomyoma

Journal of Therapeutic Ultrasound

Gina K Hesley²  Elizabeth A Stewart³  David A Woodrum²  Douglas Brown²  Amy L Weaver¹  Bijan J Borah⁴  Krzysztof R Gorny² 

[1]Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA

[2]Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA

[3]Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA

[4]Division of Health Care Policy and Research, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester MN 55901, USA

关键词: Clinical predictors;    Treatment outcomes;    MRgFUS;    Magnetic resonance-guided focused ultrasound surgery;    Symptomatology;    Uterine leiomyoma;    Fibroids;   

Others  :  801435
DOI  :  10.1186/2050-5736-1-15

 received in 2013-03-06, accepted in 2013-07-31,  发布年份 2013

【 摘 要 】

Background

Magnetic resonance-guided focused ultrasound (MRgFUS) is a relatively new minimally invasive treatment, approved by the US Food and Drug Administration in 2004 for treatments of symptomatic uterine leiomyomas (fibroids). The purpose of this work is to present retrospective cohort analysis of women that underwent commercial MRgFUS treatment between 2005 and 2009 at a single center, to identify baseline patient characteristics that predict successful MRgFUS fibroid treatment. Identifying these clinical predictors of MRgFUS would be helpful to clinicians choosing the optimal patient for this treatment modality.

Methods

One hundred thirty women with symptomatic uterine leiomyomas who underwent MRgFUS were followed up with a mean length of follow up of 17.4 ± 10.3 months. The main outcome measure of the follow-up was to identify patients who required additional fibroid treatment due to continued fibroid symptoms. Additionally, patient medical history and radiological findings obtained prior to MRgFUS were reviewed, and statistical analysis was performed to identify factors associated with reduced risk of having additional fibroid treatment.

Results

Twenty-nine patients (22.3%) underwent additional fibroid treatment due to continued or recurrent fibroid symptoms during the follow up. Cumulative incidence of additional fibroid treatment was 9.7%, 29.3%, and 44.7% at 1, 2, and 3 years following MRgFUS, respectively. In multivariable Cox proportional hazard regression analyses, older age (hazard ratio (HR) 0.54 per 5-year increase in age, 95% confidence interval 0.39 to 0.76, p < 0.001), greater number of fibroids (HR 0.19 for more than three vs. one fibroid, 95% CI 0.05 to 0.67, p = 0.033), and greater fibroid volume (HR 0.70 per doubling in volume, 95% CI 0.51 to 0.96, p = 0.025) were significantly associated with less risk of having additional fibroid treatment.

Conclusions

Older age at treatment and having multiple fibroids with larger volume are associated with a lower risk of additional intervention following MRgFUS treatment for uterine fibroids.

【 授权许可】

   
2013 Gorny et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Stewart EA: Uterine fibroids. Lancet 2001, 357(9252):293-8.
• [2]Buttram VC Jr, Reiter RC: Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981, 36(4):433-45.
• [3]Laughlin SK, Stewart EA: Uterine leiomyomas: individualizing the approach to a heterogeneous condition. Obstet Gynecol. 2011, 117(2 Pt 1):396-403.
• [4]Baird DD, Dunson DB: Why is parity protective for uterine fibroids? Epidemiology. 2003, 14(2):247-50.
• [5]Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM: High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003, 188(1):100-7.
• [6]Cramer SF, Patel A: The frequency of uterine leiomyomas. Am J Clin Pathol. 1990, 94(4):435-8.
• [7]Walker CL, Stewart EA: Uterine fibroids: the elephant in the room. Science. 2005, 308(5728):1589-92.
• [8]Al Hilli MM, Stewart EA: Magnetic resonance-guided focused ultrasound surgery. Semin Reprod Med. 2010, 28(3):242-9.
• [9]Machtinger R, Inbar Y, Cohen-Eylon S, Admon D, Alagem-Mizrachi A, Rabinovici J: MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success. Hum Reprod. 2012, 27(12):3425-31.
• [10]Hesley GK, Gorny KR, Henrichsen TL, Woodrum DA, Brown DL: A clinical review of focused ultrasound ablation with magnetic resonance guidance: an option for treating uterine fibroids. Ultrasound Q. 2008, 24(2):131-9.
• [11]Gorny KR, Hangiandreou NJ, Hesley GK, Gostout BS, McGee KP, Felmlee JP: MR guided focused ultrasound: technical acceptance measures for a clinical system. Phys Med Biol. 2006, 51(12):3155-73.
• [12]Gorny KR, Woodrum DA, Brown DL, Henrichsen TL, Weaver AL, Amrami KK, et al.: Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 2011, 22(6):857-64.
• [13]Stewart EA, Gedroyc WM, Tempany CM, Quade BJ, Inbar Y, Ehrenstein T, et al.: Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol. 2003, 189(1):48-54.
• [14]Harding G, Coyne KS, Thompson CL, Spies JB: The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Out. 2008, 6:99. BioMed Central Full Text
• [15]Kaplan ELMP: Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958, 53:457-81.
• [16]Dr C: Regression Models and Life-Tables. J R Stat Soc. 1972, 34(2):187-220.
• [17]Stewart EA, Gostout B, Rabinovici J, Kim HS, Regan L, Tempany CM: Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol. 2007, 110(2 Pt 1):279-87.
• [18]Emanuel MH, Wamsteker K, Hart AA, Metz G, Lammes FB: Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol. 1999, 93(5 Pt 1):743-8.
• [19]Nezhat FR, Roemisch M, Nezhat CH, Seidman DS, Nezhat CR: Recurrence rate after laparoscopic myomectomy. J Am Assoc Gyn Lap. 1998, 5(3):237-40.
• [20]Hanafi M: Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol. 2005, 105:877-81.
• [21]Broder MS, Goodwin S, Chen G, Tang LJ, Costantino MM, Nguyen MH, et al.: Comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet Gynecol. 2002, 100(5):864-8.
• [22]van der Kooij SM, Bipat S, Hehenkamp WJK, Ankum WM, Reekers JA: Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011, 205(4):317.e1-e18.
• [23]Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC: Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol. 2005, 106(5):933-9.
• [24]Huyck KL, Panhuysen CI, Cuenco KT, Zhang J, Goldhammer H, Jones ES, et al.: The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyomata among affected sisters. Am J Obstet Gynecol. 2008, 198:168 e1-9.
• [25]Stewart EA, Faur AV, Wise LA, Reilly RJ, Harlow BL: Predictors of subsequent surgery for uterine leiomyomata after abdominal myomectomy. Obstet Gynecol. 2002, 99(3):426-32.
• [26]Stewart EA, Morton CC: The genetics of uterine leiomyomata: what clinicians need to know. Obstet Gynecol. 2006, 107(4):917-21.
• [27]Hodge JC, Kim TM, Dreyfuss JM, Somasundaram P, Christacos NC, Rousselle M, et al.: Expression profiling of uterine leiomyomata cytogenetic subgroups reveals distinct signatures in matched myometrium: transcriptional profilingof the t(12;14) and evidence in support of predisposing genetic heterogeneity. Hum Mol Genet. 2012, 21(10):2312-29.
• [28]Funaki K, Fukunishi H, Funaki T, Sawada K, Kaji Y, Maruo T: Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol. 2007, 196(2):184 e1-6.
• [29]Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA: Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fetril Steril. 2010, 93(1):199-209.