By Ed Susman
CHICAGO -- December 1, 2008 -- Using relaxed guidelines for magnetic resonance (MR)-guided focused ultrasound, doctors were able to ablate more than half of the volume of uterine fibroids in a cohort of 80 women.
The treatment, which can take as long as 4 hours depending on the size of the fibroids, was virtually painless in the series of procedures that treated 145 fibroids.
"In general, this procedure is painless even when we are destroying more than 50% of the fibroids, as permitted in more liberal guidelines for private practice," said Suzanne D. LeBlang, MD, University MRI & Diagnostic Imaging Centers, which is affiliated with Florida Atlantic University, Boca Raton, Florida.
Dr. LeBlang described her outcomes at her outpatient clinic in a presentation on November 30 at the Radiological Society of North America (RSNA) 94th Annual Meeting.
"It is important for clinicians performing MR-guided focused ultrasound to spend time with patients, carefully explaining what they may feel after this treatment, to minimise frightened calls from women who experience some normal cramping," Dr. LeBlang said.
"I have never prescribed a patient anything more than [ibuprofen] for treatment of pain," she said.
Her patient experience indicates that the focused ultrasound ablation of "leiomyomas in an outpatient practice can yield nonperfused volume [ablation area] and shrinkage that exceed previous results from clinical trials likely due to more relaxed treatment guidelines and improved operator experience," she said.
The average treated fibroid volume was 177 cc for the 145 treated fibroids, resulting in an average nonperfused volume of 55% immediately after treatment. After 6 months, the average volume of the treated fibroids was reduced 112 cc (P < .0001) compared with baseline measurements.
"As prior studies have already proven the relationship between increased nonperfused volume and increased shrinkage with improved symptomatology, we can expect more symptomatic relief," Dr. LeBlang said.
In a second report, she noted that some women experienced focal abdominal pain -- pain that correlated well with magnetic resonance imaging that depicts abdominal fat and/or muscle necrosis.
Analysis of the treatment of the 5 women who experience this focal pain indicated that thicker amounts of anterior subcutaneous pelvic fat appear to predispose women to these symptoms.
"This focal pain -- patients tell me it hurts right here, pointing at a specific area -- may last about a day," and then the women have no more discomfort, Dr. LeBlang said. However, these women also have less successful outcomes, often with less than 50% of the fibroid being destroyed.
However, she noted that none of the 5 women had any visible burns on the overlying skin and that they did not have any type of skin discoloration.
She said that women with more than 2.5 cm of abdominal fat may be more likely to have this complication and to have less than optimal results and that they might benefit from other treatments.
[Presentation title: Leiomyoma Shrinkage After ExAblate MR-Guided Focused Ultrasound: Report of 80 Outpatient Commercial Patients. Abstract SSA11-05]
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