Comparative evaluation of combined and isolated applications of high-intensity focused ultrasound and super-selective uterine artery embolization in treatment of patients with uterine fibroids

Abstract

BACKGROUND: Uterine fibroids are a benign tumor found in two out of three women of reproductive age. The most modern methods of organ preserving treatment of uterine fibroids are uterine artery embolization, which is a minimally invasive procedure, and high intensity focused ultrasound (HIFU) ablation, which is a non-invasive procedure. According to the literature and our own experience, uterine artery embolization is ineffective in 17.1% of cases and HIFU ablation in 16% of cases, mainly due to the peculiarities of blood supply to myomatous nodes.

AIM: The aim of this study was to compare the effectiveness of the treatment of uterine fibroids using an isolated HIFU ablation technique and combined sequential application of selective embolization of uterine artery supplying the myomatous node and HIFU ablation.

MATERIALS AND METHODS: This study included two groups of patients with symptomatic uterine fibroids. Group 1 consisted of 133 patients treated using the isolated HIFU ablation, and group 2 comprised 90 patients treated sequentially using supplying the myomatous node and HIFU ablation. Age and clinical manifestations of the disease (menometrorrhagia, pain syndrome, impaired function of adjacent organs, anemia) did not differ in the both groups.

RESULTS: The following parameters were different in the study groups: the duration of ultrasound ablation (p < 0.005) and the decrease in the volume of myomatous nodes in one, six and 12 months after surgery (p < 0.001). The duration of ultrasound ablation was 610.84 (56.26) minutes in group 1 and 215.28 (70.57) minutes in group 2. In group 1, the decrease in the volume of myomatous nodes was 12.2% in one month and 58.97% in 12 months after surgery, compared to the initial value. In group 2, the decrease was 42.9% and 67.5%, respectively.

CONCLUSIONS: The combined treatment of uterine fibroids using supplying the myomatous node and FUVI ablation techniques allowed for reducing the duration of the FUVI ablation operation three times and the volume of the node by 67.5% within one year compared to group 1 (58.97%).

Keywords

uterine fibroids / high intensity focused ultrasound / thermal ablation / uterine artery embolization / gynecology

References

[1] Buianova SN, Mgeliashvili MV, Petrakova SA. Current views of the etiology, pathogenesis, and morphogenesis of uterine myoma. Rossijskij vestnik akushera-ginekologa. 2008;8(6):45−51. (In Russ.)

[2] Буянова С.Н., Мгелиашвили М.В., Петракова С.А. Современные представления об этиологии, патогенезе и морфогенезе миомы матки // Российский вестник акушера-гинеколога. 2008. Т. 8. № 6. С. 45−51.

[3] Radzinskij VE, Totchiev GF. Mioma matki: kurs na organosohranenie: informacionnyj bjulleten’. Moscow: StatusPraesens; 2014. (In Russ.)

[4] Радзинский В.Е., Тотчиев Г.Ф. Миома матки: курс на органосохранение: информационный бюллетень. Москва: StatusPraesens, 2014.

[5] Mioma matki. Ed. by I.S. Sidorova. Moscow: MIA; 2003. (In Russ.)

[6] Миома матки / ред. И.С. Сидорова. Москва: МИА, 2003.

[7] Vilos GA, Allaire C, Laberge PY, Leyland N. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157−178. DOI: 10.1016/S1701-2163(15)30338-8

[8] Vilos G.A., Allaire C., Laberge P.Y., Leyland N. The management of uterine leiomyomas // J. Obstet. Gynaecol. Can. 2015. Vol. 37. No. 2. P. 157−178. DOI: 10.1016/S1701-2163(15)30338-8

[9] Breusenko VG, Dobrohotova JuJe, Krasnova IA, et al. Jembolizacija matochnyh arterij: sovremennyj vzgljad na problemu. Chast’ II: metodicheskie aspekty. Diagnosticheskaja i intervencionnaja radiologija. 2007;1(2):56−70. (In Russ.)

[10] Бреусенко В.Г., Доброхотова Ю.Э., Краснова И.А. и др. Эмболизация маточных артерий: современный взгляд на проблему. Часть II: методические аспекты // Диагностическая и интервенционная радиология. 2007. Т. 1. № 2. С. 56−70.

[11] Kapranov SA, Breusenko VG, Dobrohotova JuJe, et al. Jembolizacija matochnyh arterij: sovremennyj vzgljad na problemu. Chast’ I: obshhie voprosy. Diagnosticheskaja i intervencionnaja radiologija. 2007;1(1):72−87. (In Russ.)

[12] Капранов С.А., Бреусенко В.Г., Доброхотова Ю.Э. и др. Эмболизация маточных артерий: современный взгляд на проблему. Часть I: общие вопросы // Диагностическая и интервенционная радиология. 2007. Т. 1. № 1. С. 72−87.

[13] Dobrohotova JuJe, Kapranov SA, Alieva AA, et al. Novyj organosohranjajushhij metod lechenija miomy matki − jembolizacija matochnyh arterij. Lechebnoe delo. 2005;(2):24−27. (In Russ.)

[14] Доброхотова Ю.Э., Капранов С.А., Алиева А.А. и др. Новый органосохраняющий метод лечения миомы матки — эмболизация маточных артерий // Лечебное дело. 2005. № 2. С. 24−27.

[15] Lubnin DM. Selektivnaja jembolizacija matochnyh arterij v algoritme organosohranjajushhego lechenija miomy matki [dissertation abstract]. Moscow; 2005. (In Russ). [cited 20 Sept 2021] Available from: https://www.dissercat.com/content/selektivnaya-embolizatsiya-matochnykh-arterii-v-algoritme-organosokhranyayushchego-lecheniya

[16] Лубнин Д.М. Селективная эмболизация маточных артерий в алгоритме органосохраняющего лечения миомы матки: автореф. дис. … канд. мед. наук. Москва, 2005. [дата обращения 20.09.2021]. Доступ по ссылке: https://www.dissercat.com/content/selektivnaya-embolizatsiya-matochnykh-arterii-v-algoritme-organosokhranyayushchego-lecheniya

[17] Nazarenko GI, Chen VSh, Dzhan L, Hitrova AN. Ul’trazvukovaja ablacija (HIFU) – vysokotehnologichnaja organosohranjajushhaja al’ternativa hirurgicheskogo lechenija opuholej. Moscow; 2008.

[18] Назаренко Г.И., Чен В.Ш., Джан Л., Хитрова А.Н. Ультразвуковая аблация (HIFU) — высокотехнологичная органосохраняющая альтернатива хирургического лечения опухолей. Москва, 2008.

[19] Lyon PC, Rai V, Price N, et al. Ultrasound-guided high intensity focused ultrasound ablation for symptomatic uterine fibroids: Preliminary clinical experience. Ultraschall Med. 2020;41(5):550−556. (In German). DOI: 10.1055/a-0891-0729

[20] Lyon P.C., Rai V., Price N., et al. Ultrasound-guided high intensity focused ultrasound ablation for symptomatic uterine fibroids: Preliminary clinical experience // Ultraschall. Med. 2020. Vol. 41. No. 5. P. 550−556. (In German). DOI: 10.1055/a-0891-0729

[21] Borah BJ, Yao X, Laughlin-Tommaso SK, et al. Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database. Obstet Gynecol. 2017;130(5):1047−1056. DOI: 10.1097/AOG.0000000000002331

[22] Borah B.J., Yao X., Laughlin-Tommaso S.K. et al. Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database // Obstet. Gynecol. 2017. Vol. 130. No. 5. P. 1047−1056. DOI: 10.1097/AOG.0000000000002331

[23] Panagiotopoulou N, Nethra S, Karavolos S, et al. Uterine-sparing minimally invasive interventions in women with uterine fibroids: a systematic review and indirect treatment comparison meta-analysis. Acta Obstet Gynecol Scand. 2014;93(9):858−867. DOI: 10.1111/aogs.12441

[24] Panagiotopoulou N., Nethra S., Karavolos S. et al. Uterine-sparing minimally invasive interventions in women with uterine fibroids: a systematic review and indirect treatment comparison meta-analysis // Acta Obstet. Gynecol. Scand. 2014. Vol. 93. No. 9. P. 858−867. DOI: 10.1111/aogs.12441

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