Sustained relief of leiomyoma symptoms by using focused ultrasound surgery.
OBJECTIVE
To assess several measures of the long-term outcome of magnetic resonance-guided focused ultrasound surgery for symptomatic uterine leiomyomata.


METHODS
Data on 359 women completing 24-month follow-up in all clinical trials of magnetic resonance-guided focused ultrasound surgery for uterine leiomyomata were analyzed. Quality of life outcomes, measured by the symptom severity score of the Uterine Fibroid Symptoms Quality Of Life Questionnaire were assessed for 24 months after treatment. Clinical endpoints, including uterine shrinkage, the need for additional leiomyoma treatment, and the time to additional leiomyoma treatment, were all assessed. The nonperfused volume ratio after treatment, calculated from the gadolinium-enhanced magnetic resonance imaging after treatment and the best measure of tissue necrosis after treatment, was used to assess outcome based on completeness of leiomyoma ablation.


RESULTS
Women undergoing magnetic resonance-guided focused ultrasound surgery for symptomatic uterine leiomyomata have durable symptom relief, as measured by the symptom severity score at 24 months, with significantly greater improvement with more complete ablation (P<.001). Survival analysis demonstrates a significant reduction in the percentage of women undergoing additional leiomyoma treatment (P=.001) in women in the high nonperfused volume group. The mean shrinkage and mean residual nonperfused volume ratio are both significantly above zero at 6 months in the high nonperfused volume group (P<.001). The incidence of adverse events is low. However, for women with minimal treatment, the risk of additional procedures is high.


CONCLUSIONS
Magnetic resonance-guided focused ultrasound surgery is an effective treatment for uterine leiomyomata and results in sustained symptomatic relief.


METHODS
III.
Departments of Obstetrics, Gynecology and Reproductive Biology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. stewart.elizabeth@mayo.edu
Elizabeth A
EA
Stewart
Bobbie
B
Gostout
Jaron
J
Rabinovici
Hyun S
HS
Kim
Lesley
L
Regan
Clare M C
CM
Tempany
D000328:Adult; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*