OAK BROOK, Ill -- February 26, 2008 -- Results from a multicentre trial have shown uterine artery embolization (UAE) to be a good alternative to hysterectomy in women with symptomatic fibroids. The findings of the Embolization Versus Hysterectomy (EMMY) Trial appear in the March issue of the journal Radiology.
The EMMY trial enrolled 177 patients with uterine fibroids and menorrhagia, eligible for hysterectomy. Of those enrolled, 88 patients were randomly assigned to undergo UAE and 89 patients were scheduled for hysterectomy. The study prospectively evaluated health-related quality of life (HRQOL) outcomes including mental and physical health, urinary and defecatory function, and overall patient satisfaction for up to 24 months after intervention.
During the 24-month follow-up period, 20 percent of women in the UAE group subsequently underwent hysterectomy due to insufficient symptomatic relief. Over the same period, HRQOL was measured six times for all women in the trial with a series of scientifically validated questionnaires, which assessed various physical, mental, and functional components contributing to quality of life, as well as overall satisfaction with the treatment.
At 6-month follow-up, study results showed that HRQOL improved significantly in both treatment groups. However, the defecation distress inventory score was improved significantly in only the UAE group at 6 months and afterward (P < .05). Six weeks after treatment, the UAE patients also scored significantly higher scores on the physical component summary, which measured factors related to physical function.
After 24 months, no HRQOL differences were observed between the two groups. Overall, improvement in the physical component summary score at 24 months was significantly higher for patients who were employed at baseline (P = .035). However, while more than 90 percent of patients were at least moderately satisfied with the treatment they received, those in the hysterectomy group reported a higher level of overall satisfaction (P = .02), The study authors note that this difference in satisfaction may be attributable to the fact that the hysterectomy patients no longer experienced menstrual cycles or worried about symptom recurrence despite previous data suggesting that fibroid regrowth is rare after UAE.
According to the National Institutes of Health, at least 25 percent of women in the US age 25 to 50 suffer from symptomatic uterine fibroids. In addition, the National Women's Health Information Center reports that fibroids are the primary reason for surgical removal of the uterus, accounting for approximately one-third of the 600,000 hysterectomies performed annually in the United States.
SOURCE: Radiological Society of America
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